Provider Demographics
NPI:1972895415
Name:GREGORY, SHARECE ANN
Entity Type:Individual
Prefix:MRS
First Name:SHARECE
Middle Name:ANN
Last Name:GREGORY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SHARECE
Other - Middle Name:ANN
Other - Last Name:GREGORY-MITCHELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSW
Mailing Address - Street 1:123 22ND ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-2706
Mailing Address - Country:US
Mailing Address - Phone:419-241-6191
Mailing Address - Fax:419-255-5623
Practice Address - Street 1:123 22ND ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-2706
Practice Address - Country:US
Practice Address - Phone:419-241-6191
Practice Address - Fax:419-255-5623
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0500488104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker