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General NPI Number Information
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NPI Number | 1063485993
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Entity Type | Individual
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Provider Name | SHARON A WIERENGA MA LCPC, LPCC
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Gender | Female
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Dates
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Enumeration Date | 02/10/2006
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Last Update Date | 08/13/2020
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Provider Practice Location Address
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Address Line | 2439 MARSEILLES WAY
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City | COSTA MESA
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State | CA
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Zip | 92627-1417
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Country | US
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Telephone | 708-254-8999
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Fax |
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Provider Business Mailing Address
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Address Line | 2439 MARSEILLES WAY
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City | COSTA MESA
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State | CA
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Zip | 92627-1417
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Country | US
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Telephone | 708-254-8999
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180005274
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2132
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License Number State | CA
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