Provider Demographics
NPI:1992015127
Name:CARRIGG BAILEY, SHARON CHRISTINE
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:CHRISTINE
Last Name:CARRIGG BAILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S LUCIA AVE
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3507
Mailing Address - Country:US
Mailing Address - Phone:310-944-2534
Mailing Address - Fax:
Practice Address - Street 1:3820 DEL AMO BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-2150
Practice Address - Country:US
Practice Address - Phone:310-944-2534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47071106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist