Provider Demographics
NPI:1447970777
Name:COLLINS, SHARON (MA)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:CHER
Other - Middle Name:
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:20807 106TH ST E
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-7904
Mailing Address - Country:US
Mailing Address - Phone:253-826-4741
Mailing Address - Fax:
Practice Address - Street 1:20807 106TH ST E
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-7904
Practice Address - Country:US
Practice Address - Phone:253-826-4741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA404599C103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool