Provider Demographics
NPI:1538455886
Name:BALCOME, SHARON VINSON (PHD)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:VINSON
Last Name:BALCOME
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 CHUCK DAWLEY BLVD
Mailing Address - Street 2:BLDG E, STE 104
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4146
Mailing Address - Country:US
Mailing Address - Phone:843-849-2295
Mailing Address - Fax:
Practice Address - Street 1:1029 LAW LN
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-9558
Practice Address - Country:US
Practice Address - Phone:843-209-2015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2246101Y00000X
SC199106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor