MEDICARE: SHARON DANCER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	APC006254	GA
2	101YP2500X	Professional Counselor	LPC011875	GA

General Provider Information

NPI Number	:	1174141436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON DANCER

Provider Business Mailing Address
First Line	:	301 WILLOW LAKE DR
Second Line	:
City	:	LEESBURG
State	:	GA
Zip	:	31763-5417
Country	:	US
Telephone Number	:	843-252-3595
Fax Number	:

Provider Business Practice Location Address
First Line	:	1511 W 3RD AVE STE 104
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31707-3658
Country	:	US
Telephone Number	:	229-483-5050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2020
Last Update Date	:	11/16/2020

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Directions to “ SHARON DANCER ” Practice Location

Language	Start Address	Practice Location

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