Provider Demographics
NPI:1316451834
Name:WOODFORD - BEALE, SHARRON (CADC CAS)
Entity type:Individual
Prefix:
First Name:SHARRON
Middle Name:
Last Name:WOODFORD - BEALE
Suffix:
Gender:F
Credentials:CADC CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9298 CITRUS AVE APT B
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-5581
Mailing Address - Country:US
Mailing Address - Phone:909-997-2066
Mailing Address - Fax:
Practice Address - Street 1:2275 E COOLEY DR
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-6324
Practice Address - Country:US
Practice Address - Phone:909-370-1777
Practice Address - Fax:909-370-1776
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-20
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
C052070418101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)