Provider Demographics
NPI:1881155885
Name:SHARPE, MARJORIE DAPHANE
Entity type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:DAPHANE
Last Name:SHARPE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MARJORIE
Other - Middle Name:SHARPE
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:225 W WILDING DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-3735
Mailing Address - Country:US
Mailing Address - Phone:334-202-0635
Mailing Address - Fax:
Practice Address - Street 1:225 W WILDING DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-3735
Practice Address - Country:US
Practice Address - Phone:334-202-0635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-31
Last Update Date:2019-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty