Provider Demographics
NPI:1336416296
Name:WHITE, SHARON JEANETTE (LISW-S)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:JEANETTE
Last Name:WHITE
Suffix:
Gender:
Credentials:LISW-S
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:JEANETTE
Other - Last Name:MORALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2419 GRAND HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32408-7047
Mailing Address - Country:US
Mailing Address - Phone:347-278-3702
Mailing Address - Fax:
Practice Address - Street 1:2419 GRAND HARBOR DR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32408-7047
Practice Address - Country:US
Practice Address - Phone:347-278-3702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.22038801041C0700X, 1041C0700X
NY083260-1101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor