Provider Demographics
NPI:1194484840
Name:KASHKOULI, SHARON ROGERS (LPC)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:ROGERS
Last Name:KASHKOULI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23301 RIDGE ROUTE DR SPC 129
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1729
Mailing Address - Country:US
Mailing Address - Phone:312-513-2018
Mailing Address - Fax:
Practice Address - Street 1:1400 QUAIL ST STE 210
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2761
Practice Address - Country:US
Practice Address - Phone:312-513-2018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180010279101YM0800X
CA6788101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health