MEDICARE: CHARITY FAITH COLQUETT-SHARP LCISW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6763C	AL

General Provider Information

NPI Number	:	1639011612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARITY FAITH COLQUETT-SHARP LCISW

Provider Business Mailing Address
First Line	:	1110 BOLL WEEVIL CIR STE D
Second Line	:
City	:	ENTERPRISE
State	:	AL
Zip	:	36330-1390
Country	:	US
Telephone Number	:	334-806-1262
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 BOLL WEEVIL CIR STE D
Second Line	:
City	:	ENTERPRISE
State	:	AL
Zip	:	36330-1390
Country	:	US
Telephone Number	:	334-806-1262
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2026
Last Update Date	:	04/08/2026

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