Doctor Name: | MR. JUSTIN HARRIS |
NPI Number: | 1801259965 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 29252995 |
Business Practice Address: | 241 Grant St West End, NC - 273768377 |
Business Phone Number: | 9106733535 |
Business Fax Number: | |
Mailing Address: | 241 Grant St, WEST END |
State: | NC |
Postal Code: | 273768377 |
Phone Number: | 9106733535 |
Fax Number: | |
NPI Enumeration Date: | 04/05/2016 |
NPI Last Update Date: | 04/05/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 29252995 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |