Provider Demographics
NPI:1992087233
Name:WESTON, SHARON W (LCSW)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:W
Last Name:WESTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5125 RIVER CHASE RDG
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-4470
Mailing Address - Country:US
Mailing Address - Phone:336-765-5439
Mailing Address - Fax:336-760-2031
Practice Address - Street 1:5125 RIVER CHASE RDG
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-4470
Practice Address - Country:US
Practice Address - Phone:336-765-5439
Practice Address - Fax:336-760-2031
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCOO35681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical