Provider Demographics
NPI:1073225652
Name:HARRIAGE, DEJA NICOLE
Entity Type:Individual
Prefix:
First Name:DEJA
Middle Name:NICOLE
Last Name:HARRIAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4005 LADYS SECRET DR
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-5716
Mailing Address - Country:US
Mailing Address - Phone:917-951-5685
Mailing Address - Fax:
Practice Address - Street 1:4005 LADYS SECRET DR
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-5716
Practice Address - Country:US
Practice Address - Phone:917-951-5685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst