Provider Demographics
NPI:1588112254
Name:BALL DALE, SHARON KAY
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:KAY
Last Name:BALL DALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:KAY
Other - Last Name:BALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC-MHSP
Mailing Address - Street 1:106 MISSION CT STE 904
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-6481
Mailing Address - Country:US
Mailing Address - Phone:615-403-8150
Mailing Address - Fax:
Practice Address - Street 1:106 MISSION CT STE 904
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-6481
Practice Address - Country:US
Practice Address - Phone:615-403-8150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001826101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health