Provider Demographics
NPI:1063157840
Name:RICH, SHARON
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:RICH
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 1:2803 MORGAN FARM CT
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-3042
Mailing Address - Country:US
Mailing Address - Phone:470-573-5477
Mailing Address - Fax:
Practice Address - Street 1:2803 MORGAN FARM CT
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-3042
Practice Address - Country:US
Practice Address - Phone:470-573-5477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-04
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA103K00000X
171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst