Healthcare Provider Details

I. General information

NPI: 1740529890
Provider Name (Legal Business Name): SHARON OLETA DURHAM M.DIV.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2013
Last Update Date: 02/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 E CEDAR ROCK ST
PICKENS SC
29671-2349
US

IV. Provider business mailing address

523 E CEDAR ROCK ST
PICKENS SC
29671-2349
US

V. Phone/Fax

Practice location:
  • Phone: 864-723-4446
  • Fax:
Mailing address:
  • Phone: 864-723-4446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: