Provider Demographics
NPI:1508656489
Name:SHARP, KATHRYN (MS, PPS)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:SHARP
Suffix:
Gender:F
Credentials:MS, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:572 ESTABROOK ST
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-3512
Mailing Address - Country:US
Mailing Address - Phone:510-407-9448
Mailing Address - Fax:
Practice Address - Street 1:217 REX AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-2020
Practice Address - Country:US
Practice Address - Phone:510-407-9448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250052082101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool