Healthcare Provider Details

I. General information

NPI: 1437540937
Provider Name (Legal Business Name): CARMEN SHARP MS, NCC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CARMEN BOULDIN

II. Dates (important events)

Enumeration Date: 02/05/2015
Last Update Date: 08/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1893 CLIFF GOOKIN BLVD STE B
TUPELO MS
38801
US

IV. Provider business mailing address

2434 S EASON BLVD
TUPELO MS
38804-6942
US

V. Phone/Fax

Practice location:
  • Phone: 662-346-4584
  • Fax:
Mailing address:
  • Phone: 662-524-3323
  • Fax: 662-680-6416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2170
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: