Provider Demographics
NPI:1831733575
Name:FORD, SHARIE KADICE
Entity type:Individual
Prefix:
First Name:SHARIE
Middle Name:KADICE
Last Name:FORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13160 ASTER RD
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-9322
Mailing Address - Country:US
Mailing Address - Phone:760-662-3696
Mailing Address - Fax:
Practice Address - Street 1:13160 ASTER RD
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-9322
Practice Address - Country:US
Practice Address - Phone:760-662-3696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst