Provider Demographics
NPI:1396317103
Name:CLARK, SHARON MARIE (LPC)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:MARIE
Last Name:CLARK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 STATE ROUTE 118
Mailing Address - Street 2:
Mailing Address - City:SWEET VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18656-2039
Mailing Address - Country:US
Mailing Address - Phone:570-406-5236
Mailing Address - Fax:
Practice Address - Street 1:651 STATE ROUTE 118
Practice Address - Street 2:
Practice Address - City:SWEET VALLEY
Practice Address - State:PA
Practice Address - Zip Code:18656-2039
Practice Address - Country:US
Practice Address - Phone:570-406-5236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC011284101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional