Provider Demographics
NPI:1922511567
Name:SHARPE, EDDIE LAMAR JR
Entity Type:Individual
Prefix:
First Name:EDDIE
Middle Name:LAMAR
Last Name:SHARPE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 RIVER HAVEN CIR
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-1234
Mailing Address - Country:US
Mailing Address - Phone:706-590-2630
Mailing Address - Fax:205-208-9870
Practice Address - Street 1:2700 CORPORATE DR STE 200
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-2733
Practice Address - Country:US
Practice Address - Phone:706-590-2630
Practice Address - Fax:205-208-9870
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8649101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional