Provider Demographics
NPI:1871842062
Name:KELLEY, SHARIE DARLENE (CSWA, CADC I)
Entity Type:Individual
Prefix:MS
First Name:SHARIE
Middle Name:DARLENE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:CSWA, CADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 SE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-2224
Mailing Address - Country:US
Mailing Address - Phone:541-276-6207
Mailing Address - Fax:541-276-4628
Practice Address - Street 1:331 SE 2ND ST
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-2224
Practice Address - Country:US
Practice Address - Phone:541-276-6207
Practice Address - Fax:541-276-4628
Is Sole Proprietor?:No
Enumeration Date:2012-09-04
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA52461041C0700X
OR13-11-01101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)