Provider Demographics
NPI:1205902616
Name:SHARPE, TIMOTHEA NMN (MSW, MDIV, LISW-CP)
Entity type:Individual
Prefix:MS
First Name:TIMOTHEA
Middle Name:NMN
Last Name:SHARPE
Suffix:
Gender:F
Credentials:MSW, MDIV, LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 SEAGULL LN
Mailing Address - Street 2:
Mailing Address - City:PROSPERITY
Mailing Address - State:SC
Mailing Address - Zip Code:29127-7112
Mailing Address - Country:US
Mailing Address - Phone:803-760-8475
Mailing Address - Fax:803-364-3566
Practice Address - Street 1:10000 BROAD RIVER RD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2361
Practice Address - Country:US
Practice Address - Phone:803-760-8475
Practice Address - Fax:803-364-3566
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC34401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical