Provider Demographics
NPI:1215821970
Name:SHARE SELF CARE LLC
Entity type:Organization
Organization Name:SHARE SELF CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEER SUPPORT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:COWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-355-2359
Mailing Address - Street 1:5820 E WT HARRIS BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-3600
Mailing Address - Country:US
Mailing Address - Phone:980-355-2359
Mailing Address - Fax:
Practice Address - Street 1:4731 GOOSE CREEK DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-0263
Practice Address - Country:US
Practice Address - Phone:980-355-2359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-06
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty