Basic Information
| Provider Information | |||||||||
| NPI: | 1649603978 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EARLE | ||||||||
| FirstName: | SHARON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1050 WILSHIRE DR STE 175 | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480841590 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2484221430 | ||||||||
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| Practice Location | |||||||||
| Address1: | 39425 GARFIELD RD STE 23 | ||||||||
| Address2: | |||||||||
| City: | CLINTON TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480384651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612547086 | ||||||||
| FaxNumber: | 6612547108 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2013 | ||||||||
| LastUpdateDate: | 08/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 106H00000X | 4101007191 | MI | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.