Healthcare Provider Details

I. General information

NPI: 1184082794
Provider Name (Legal Business Name): SHARON DENISE WILEY MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2016
Last Update Date: 02/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4623 S ESPANA ST
CENTENNIAL CO
80015-5818
US

IV. Provider business mailing address

4623 S ESPANA ST
CENTENNIAL CO
80015-5818
US

V. Phone/Fax

Practice location:
  • Phone: 720-435-6993
  • Fax: 303-237-6873
Mailing address:
  • Phone: 720-435-6993
  • Fax: 303-237-6873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number27-3647565
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: