Provider Demographics
NPI:1316084486
Name:MARTIN, SHARON INELLE (LMSW, ACSW)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:INELLE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29300 PINETREE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-1643
Mailing Address - Country:US
Mailing Address - Phone:248-390-1017
Mailing Address - Fax:
Practice Address - Street 1:30555 SOUTHFIELD RD STE 510
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-7753
Practice Address - Country:US
Practice Address - Phone:248-390-1017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010651581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical