Provider Demographics
NPI:1891435244
Name:SHARKEY, KERRY (LCSWA)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:SHARKEY
Suffix:
Gender:M
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 REDBERRY DR
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:NC
Mailing Address - Zip Code:28574-6366
Mailing Address - Country:US
Mailing Address - Phone:910-320-0796
Mailing Address - Fax:
Practice Address - Street 1:3886 HENDERSON DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-5219
Practice Address - Country:US
Practice Address - Phone:910-938-9833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0159821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical