Provider Demographics
NPI:1255888442
Name:SHARPE, ELLISON BATES (LPCA, NCC)
Entity type:Individual
Prefix:
First Name:ELLISON
Middle Name:BATES
Last Name:SHARPE
Suffix:
Gender:F
Credentials:LPCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2132 FLORAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-6024
Mailing Address - Country:US
Mailing Address - Phone:803-467-8772
Mailing Address - Fax:
Practice Address - Street 1:8401 UNIVERSITY EXEC PARK DR
Practice Address - Street 2:SUITE 106
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3386
Practice Address - Country:US
Practice Address - Phone:704-716-1146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12559101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health