Provider Demographics
NPI:1184046765
Name:HETHERINGTON, SHARON ANN (LPC)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:ANN
Last Name:HETHERINGTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5207 LAKE SHORE DR STE B
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-1732
Mailing Address - Country:US
Mailing Address - Phone:254-772-8055
Mailing Address - Fax:254-772-3019
Practice Address - Street 1:5207 LAKE SHORE DR STE B
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-1732
Practice Address - Country:US
Practice Address - Phone:254-772-8055
Practice Address - Fax:254-772-3019
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-15
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12708101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health