Provider Demographics
NPI:1285789800
Name:HOPPER, SHARON ROSE (LCAS)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:ROSE
Last Name:HOPPER
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:ROSE
Other - Last Name:HOPPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCAS CCS
Mailing Address - Street 1:105 PARK PLACE AVE APT D
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-6056
Mailing Address - Country:US
Mailing Address - Phone:828-475-6778
Mailing Address - Fax:828-433-1287
Practice Address - Street 1:203 WHITE ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3417
Practice Address - Country:US
Practice Address - Phone:828-433-1221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1629101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6111969Medicaid