Healthcare Provider Details

I. General information

NPI: 1063064822
Provider Name (Legal Business Name): SHERE NIKKOLE PADILLA LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19969 GREENLEY RD STE A
SONORA CA
95370-5908
US

IV. Provider business mailing address

19969 GREENLEY RD STE A
SONORA CA
95370-5908
US

V. Phone/Fax

Practice location:
  • Phone: 209-928-5400
  • Fax:
Mailing address:
  • Phone: 209-928-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number17253
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10955
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: