Basic Information
Provider Information
NPI: 1982860748
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SHARP
FirstName: DARCIE
MiddleName: L.
NamePrefix: MS.
NameSuffix:  
Credential: PSY.D
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 35
Address2:  
City: ROSEVILLE
State: CA
PostalCode: 956610035
CountryCode: US
TelephoneNumber: 9168344596
FaxNumber:  
Practice Location
Address1: 100 PRISON RD
Address2:  
City: REPRESA
State: CA
PostalCode: 956713000
CountryCode: US
TelephoneNumber: 9169858610
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/31/2008
LastUpdateDate: 06/28/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103T00000X  Y Behavioral Health & Social Service ProvidersPsychologist 

No ID Information.


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