Provider Demographics
NPI:1861191256
Name:SHARP, JOHN MATTHEW (LRIC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MATTHEW
Last Name:SHARP
Suffix:
Gender:M
Credentials:LRIC
Other - Prefix:MR
Other - First Name:MATT
Other - Middle Name:
Other - Last Name:SHARP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:505 S INDEPENDENCE BLVD STE 213
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1150
Mailing Address - Country:US
Mailing Address - Phone:757-376-8167
Mailing Address - Fax:757-452-4447
Practice Address - Street 1:505 S INDEPENDENCE BLVD STE 213
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1150
Practice Address - Country:US
Practice Address - Phone:757-376-8167
Practice Address - Fax:757-452-4447
Is Sole Proprietor?:No
Enumeration Date:2023-02-24
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704015675101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health