Provider Demographics
NPI:1396901815
Name:HALEY, SHARON ANDREA (BA)
Entity type:Individual
Prefix:MISS
First Name:SHARON
Middle Name:ANDREA
Last Name:HALEY
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17204 WALL ST
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-1165
Mailing Address - Country:US
Mailing Address - Phone:310-327-4191
Mailing Address - Fax:
Practice Address - Street 1:704 W 8TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3017
Practice Address - Country:US
Practice Address - Phone:310-832-7545
Practice Address - Fax:310-833-8580
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health