Healthcare Provider Details

I. General information

NPI: 1538171178
Provider Name (Legal Business Name): KELLY R SHARPES LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 05/08/2020
Certification Date: 05/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 UNIVERSITY BLVD
HARRISONBURG VA
22801
US

IV. Provider business mailing address

1241 N MAIN ST
HARRISONBURG VA
22802-4632
US

V. Phone/Fax

Practice location:
  • Phone: 540-564-5629
  • Fax: 540-433-4338
Mailing address:
  • Phone: 540-434-1941
  • Fax: 540-434-0132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701003342
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: