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General NPI Number Information
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NPI Number | 1174882567
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Entity Type | Individual
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Provider Name | SHAREEN WORNSON L.P.C., LCPC
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Gender | Female
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Dates
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Enumeration Date | 05/07/2012
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Last Update Date | 10/21/2020
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Provider Practice Location Address
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Address Line | 866 PORT CLYDE ROAD
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City | PORT CLYDE
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State | ME
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Zip | 04855
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Country | US
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Telephone | 207-691-3267
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 342
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City | PORT CLYDE
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State | ME
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Zip | 04855-0342
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Country | US
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Telephone | 207-691-3267
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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 | 64219
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License Number State | TX
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