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General NPI Number Information
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NPI Number | 1265663504
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Entity Type | Individual
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Provider Name | SHARON SUZETTE SMITH-WILBORN LMSW, LISAC
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Gender | Female
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Dates
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Enumeration Date | 08/04/2009
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Last Update Date | 11/30/2011
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Provider Practice Location Address
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Address Line | 4839 S DARROW DR G162
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City | TEMPE
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State | AZ
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Zip | 85282-6684
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Country | US
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Telephone | 480-234-2404
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Fax |
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Provider Business Mailing Address
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Address Line | 4839 S DARROW DR G162
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City | TEMPE
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State | AZ
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Zip | 85282-6684
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Country | US
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Telephone | 480-234-2404
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LMSW - 8441
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LISAC - 11665
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License Number State | AZ
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