Healthcare Provider Details

I. General information

NPI: 1558535443
Provider Name (Legal Business Name): SHARON D. DELOACH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 S REILLY RD
FAYETTEVILLE NC
28314-1825
US

IV. Provider business mailing address

4508 PARK KNOLL LN
FAYETTEVILLE NC
28304-5100
US

V. Phone/Fax

Practice location:
  • Phone: 910-491-6356
  • Fax: 910-491-8218
Mailing address:
  • Phone: 910-214-3367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6873
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: