Healthcare Provider Details

I. General information

NPI: 1962761932
Provider Name (Legal Business Name): SHARON CARPINO LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2012
Last Update Date: 05/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 CEDAR ST
GIRARD KS
66743-2056
US

IV. Provider business mailing address

911 E CENTENNIAL DR
PITTSBURG KS
66762-6601
US

V. Phone/Fax

Practice location:
  • Phone: 620-724-8806
  • Fax: 620-724-6170
Mailing address:
  • Phone: 620-231-5130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number460
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: