Provider Demographics
NPI:1487923785
Name:HOLBERT, SHARON (MA, BCBA)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:
Last Name:HOLBERT
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3309 DARRAH AVE
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-9187
Mailing Address - Country:US
Mailing Address - Phone:304-319-2282
Mailing Address - Fax:
Practice Address - Street 1:3309 DARRAH AVE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-9187
Practice Address - Country:US
Practice Address - Phone:304-319-2282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-11-8117103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-11-8117OtherBEHAVIOR ANALYST CERTIFICATION BOARD CERTIFICATION NUMBER