Provider Demographics
NPI:1366552457
Name:GRANT, SHARON L (MA)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:L
Last Name:GRANT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 MOWRY SQ
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354-2612
Mailing Address - Country:US
Mailing Address - Phone:509-943-8688
Mailing Address - Fax:509-946-2355
Practice Address - Street 1:1776 FOWLER ST STE 34
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4830
Practice Address - Country:US
Practice Address - Phone:509-783-6558
Practice Address - Fax:509-783-5539
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6209101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health