Provider Demographics
NPI:1245979848
Name:SHARIF, AMAL MOHAMED (LPCC)
Entity type:Individual
Prefix:MS
First Name:AMAL
Middle Name:MOHAMED
Last Name:SHARIF
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 OAK ST
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-4403
Mailing Address - Country:US
Mailing Address - Phone:651-307-4284
Mailing Address - Fax:
Practice Address - Street 1:1821 UNIVERSITY AVE W STE 107-30
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-0049
Practice Address - Country:US
Practice Address - Phone:651-307-4284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC03301101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health