Healthcare Provider Details

I. General information

NPI: 1932657160
Provider Name (Legal Business Name): ADAM SHARE PSY.D., LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2016
Last Update Date: 09/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 MAIN ST
PARK RIDGE IL
60068-4060
US

IV. Provider business mailing address

32 MAIN ST
PARK RIDGE IL
60068-4060
US

V. Phone/Fax

Practice location:
  • Phone: 847-823-4444
  • Fax:
Mailing address:
  • Phone: 847-823-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.012302
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: