Provider Demographics
NPI:1225347271
Name:FAIRLEY, SHARON DENICE (MS, LCMHC)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:DENICE
Last Name:FAIRLEY
Suffix:
Gender:F
Credentials:MS, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3610 BUSH ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7511
Mailing Address - Country:US
Mailing Address - Phone:877-876-3783
Mailing Address - Fax:855-420-6402
Practice Address - Street 1:715 HIGHGATE PL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1721
Practice Address - Country:US
Practice Address - Phone:919-948-5502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-24
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8296101YM0800X, 101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor