Provider Demographics
NPI:1285170225
Name:ELDREDGE, SHARISE (LCSW)
Entity type:Individual
Prefix:
First Name:SHARISE
Middle Name:
Last Name:ELDREDGE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9617 MALONEY RD
Mailing Address - Street 2:
Mailing Address - City:FORT BELVOIR
Mailing Address - State:VA
Mailing Address - Zip Code:22060-2215
Mailing Address - Country:US
Mailing Address - Phone:352-428-4535
Mailing Address - Fax:
Practice Address - Street 1:9617 MALONEY RD
Practice Address - Street 2:
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-2215
Practice Address - Country:US
Practice Address - Phone:352-428-4535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-15
Last Update Date:2017-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040093341041C0700X
FL132401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical