Healthcare Provider Details

I. General information

NPI: 1609100742
Provider Name (Legal Business Name): ANNA LAYNE SHARPE LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNA LAYNE SMITH LMHC

II. Dates (important events)

Enumeration Date: 09/22/2009
Last Update Date: 06/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 E OAKDALE AVE
CRESTVIEW FL
32539-3547
US

IV. Provider business mailing address

259 E OAKDALE AVE
CRESTVIEW FL
32539-3547
US

V. Phone/Fax

Practice location:
  • Phone: 850-682-1234
  • Fax:
Mailing address:
  • Phone: 850-682-1234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: