Provider Demographics
NPI:1205874419
Name:CARPENTER, SHARON L (PCC-S, LICDC)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:L
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:PCC-S, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7867 S RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:OH
Mailing Address - Zip Code:44202-8605
Mailing Address - Country:US
Mailing Address - Phone:440-543-5945
Mailing Address - Fax:440-543-5945
Practice Address - Street 1:23360 CHAGRIN BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5547
Practice Address - Country:US
Practice Address - Phone:440-460-4579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE2963101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional