Provider Demographics
NPI:1245497411
Name:SHARP, CONSTANCE B (PHD)
Entity type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:B
Last Name:SHARP
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:CONNIE
Other - Middle Name:
Other - Last Name:SHARP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:12430 LAKELAND AVE SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498
Mailing Address - Country:US
Mailing Address - Phone:253-279-5876
Mailing Address - Fax:
Practice Address - Street 1:12430 LAKELAND AVE SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498
Practice Address - Country:US
Practice Address - Phone:253-279-5876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60043856103T00000X
WAPSYC.PY.60043856103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling