Basic Information
| Provider Information | |||||||||
| NPI: | 1023527710 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STINES | ||||||||
| FirstName: | SHARON | ||||||||
| MiddleName: | ROSE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LPPC 6413 | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | STINES | ||||||||
| OtherFirstName: | SHARIE | ||||||||
| OtherMiddleName: | ROSE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 14181 TELEGRAPH RD | ||||||||
| Address2: | |||||||||
| City: | WHITTIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906042554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5622730722 | ||||||||
| FaxNumber: | 5628644596 | ||||||||
| Practice Location | |||||||||
| Address1: | 271 W. IMPERIAL HWY, SUITE C | ||||||||
| Address2: | |||||||||
| City: | LA HABRA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5622730722 | ||||||||
| FaxNumber: | 5628644596 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 157107 | CA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | PCCI3095 | CA | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | LPCC6413 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 562-706-4251 | 01 | CA | MEDI-CAL | OTHER |