Provider Demographics
NPI:1023527710
Name:STINES, SHARON ROSE (LPPC 6413)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:ROSE
Last Name:STINES
Suffix:
Gender:F
Credentials:LPPC 6413
Other - Prefix:
Other - First Name:SHARIE
Other - Middle Name:ROSE
Other - Last Name:STINES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14181 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90604-2554
Mailing Address - Country:US
Mailing Address - Phone:562-273-0722
Mailing Address - Fax:562-864-4596
Practice Address - Street 1:271 W. IMPERIAL HWY, SUITE C
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631
Practice Address - Country:US
Practice Address - Phone:562-273-0722
Practice Address - Fax:562-864-4596
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA157107101YA0400X
CAPCCI3095101YP2500X
CALPCC6413101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA562-706-4251OtherMEDI-CAL