Provider Demographics
NPI:1386283828
Name:GILREATH, SHARA (MA, LPCA)
Entity type:Individual
Prefix:MRS
First Name:SHARA
Middle Name:
Last Name:GILREATH
Suffix:
Gender:F
Credentials:MA, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 DANBURY LN
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-8901
Mailing Address - Country:US
Mailing Address - Phone:704-437-6712
Mailing Address - Fax:
Practice Address - Street 1:1210 DAVIE AVE
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3512
Practice Address - Country:US
Practice Address - Phone:704-437-6712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15412101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA15412OtherBLUE CROSS BLUE SHIELD OF NORTH CAROLINA
NCA15412Medicaid