Provider Demographics
NPI:1124186697
Name:HARRISON, THOMAS AUSTIN (LPA)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:AUSTIN
Last Name:HARRISON
Suffix:
Gender:M
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1701 WESTCHESTER DRIVE
Mailing Address - Street 2:SUITE 850
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7254
Mailing Address - Country:US
Mailing Address - Phone:336-802-2400
Mailing Address - Fax:336-802-2001
Practice Address - Street 1:721 N ELM ST
Practice Address - Street 2:SUITE 101
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-3929
Practice Address - Country:US
Practice Address - Phone:336-802-2205
Practice Address - Fax:336-802-2599
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0826103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107478Medicaid
NC0826OtherPSYCHOLOGY BOARD