Provider Demographics
NPI:1972637635
Name:HACKITT-HOLLIDAY, SHARON LEE (MSW, LCDC)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:LEE
Last Name:HACKITT-HOLLIDAY
Suffix:
Gender:F
Credentials:MSW, LCDC
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:LEE
Other - Last Name:HACKITT-PUTERBAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16055 VENTURA BLVD
Mailing Address - Street 2:SUITE 828
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2601
Mailing Address - Country:US
Mailing Address - Phone:818-585-3951
Mailing Address - Fax:818-784-0954
Practice Address - Street 1:16055 VENTURA BLVD
Practice Address - Street 2:SUITE 828
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2601
Practice Address - Country:US
Practice Address - Phone:818-585-3951
Practice Address - Fax:818-784-0954
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225400000X
CA104563101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA104563OtherCALIFORNIA CERTIFICATION BOARD OF CHEMICAL DEPENDENCY COUNSELORS