Healthcare Provider Details

I. General information

NPI: 1205218567
Provider Name (Legal Business Name): LEAH SHARPE AA, CADC I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2015
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 MARINE DR SUITE 201
ASTORIA OR
97103-4059
US

IV. Provider business mailing address

105 SW 14TH ST UNIT B
WARRENTON OR
97146-9443
US

V. Phone/Fax

Practice location:
  • Phone: 503-325-2067
  • Fax:
Mailing address:
  • Phone: 503-298-9654
  • Fax: 503-325-2153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number13-12-39
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: