Healthcare Provider Details

I. General information

NPI: 1326193079
Provider Name (Legal Business Name): SHARON ANN LAKE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHARON ANN BAILEY HAMLEN

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 05/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2509 EIDE ST.
ANCHORAGE AK
99503
US

IV. Provider business mailing address

8230 KIP CT.
ANCHORAGE AK
99507-3245
US

V. Phone/Fax

Practice location:
  • Phone: 907-244-8872
  • Fax: 907-563-3217
Mailing address:
  • Phone: 907-244-8872
  • Fax: 907-563-3217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number614
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: