Provider Demographics
NPI:1861680852
Name:FORTSON, SHARON DELEE (MS, LPE-I)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:DELEE
Last Name:FORTSON
Suffix:
Gender:F
Credentials:MS, LPE-I
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:DELEE
Other - Last Name:RICKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8835 DENNETTE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-8650
Mailing Address - Country:US
Mailing Address - Phone:501-500-1389
Mailing Address - Fax:949-577-4838
Practice Address - Street 1:8835 DENNETTE RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-8650
Practice Address - Country:US
Practice Address - Phone:501-500-1389
Practice Address - Fax:949-577-4838
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR12-02EI101YM0800X, 102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health