Provider Demographics
NPI:1366229833
Name:BEATTY, SHARON DENISE HAZEL
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:DENISE HAZEL
Last Name:BEATTY
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 1:1308 SKYLER DR
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-6757
Mailing Address - Country:US
Mailing Address - Phone:704-361-8359
Mailing Address - Fax:
Practice Address - Street 1:1308 SKYLER DR
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-6757
Practice Address - Country:US
Practice Address - Phone:704-361-8359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13772101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health