Provider Demographics
NPI:1104208917
Name:ANDERSON-HARRIS, DESIRRAE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DESIRRAE
Middle Name:
Last Name:ANDERSON-HARRIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 MICAHS WAY N
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-6001
Mailing Address - Country:US
Mailing Address - Phone:910-580-4357
Mailing Address - Fax:910-764-6726
Practice Address - Street 1:917 MICAHS WAY N
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NC
Practice Address - Zip Code:28390-6001
Practice Address - Country:US
Practice Address - Phone:910-580-4357
Practice Address - Fax:910-764-6726
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-29
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0086771041C0700X
NCC101451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical