Provider Demographics
NPI:1588405153
Name:SHARP, MIRANDA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:
Last Name:SHARP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:
Other - Last Name:LIGHTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:705 RIVA RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SNEADS FERRY
Mailing Address - State:NC
Mailing Address - Zip Code:28460-9333
Mailing Address - Country:US
Mailing Address - Phone:727-687-4447
Mailing Address - Fax:
Practice Address - Street 1:705 RIVA RIDGE RD
Practice Address - Street 2:
Practice Address - City:SNEADS FERRY
Practice Address - State:NC
Practice Address - Zip Code:28460-9333
Practice Address - Country:US
Practice Address - Phone:727-687-4447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0168801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical