Provider Demographics
NPI:1992051684
Name:PETRIE, SHARON ANN (LPC)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:ANN
Last Name:PETRIE
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 1:1861 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-1367
Mailing Address - Country:US
Mailing Address - Phone:334-699-1540
Mailing Address - Fax:334-699-1543
Practice Address - Street 1:1861 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-1367
Practice Address - Country:US
Practice Address - Phone:334-699-1540
Practice Address - Fax:334-699-1543
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1548101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional