Healthcare Provider Details

I. General information

NPI: 1033026547
Provider Name (Legal Business Name): JUSTIN CHASE SHARP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 22ND ST
SACRAMENTO CA
95816-3503
US

IV. Provider business mailing address

500 22ND ST
SACRAMENTO CA
95816-3503
US

V. Phone/Fax

Practice location:
  • Phone: 916-442-3979
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRT1456300826
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: