Provider Demographics
NPI:1295903417
Name:DAVIS, SHARON L (MASTER OF SCIENCE)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MASTER OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14828 167TH PL SE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-8828
Mailing Address - Country:US
Mailing Address - Phone:425-228-5188
Mailing Address - Fax:
Practice Address - Street 1:14828 167TH PL SE
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98059-8828
Practice Address - Country:US
Practice Address - Phone:425-228-5188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005891101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health