Provider Demographics
NPI:1821168980
Name:KING, SHARON ELAINE (MS)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:ELAINE
Last Name:KING
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 WONDERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-4012
Mailing Address - Country:US
Mailing Address - Phone:704-365-0831
Mailing Address - Fax:
Practice Address - Street 1:3111 SPRINGBANK LN
Practice Address - Street 2:SUITE G
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3372
Practice Address - Country:US
Practice Address - Phone:704-517-0120
Practice Address - Fax:704-540-5866
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLPC 2188101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102433Medicaid