Provider Demographics
NPI:1174044044
Name:HARRISON, QUENISHA LOUISE
Entity Type:Individual
Prefix:
First Name:QUENISHA
Middle Name:LOUISE
Last Name:HARRISON
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 1:150 BW THOMAS DR STE 114
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-7207
Mailing Address - Country:US
Mailing Address - Phone:706-817-5133
Mailing Address - Fax:
Practice Address - Street 1:150 BW THOMAS DR STE 114
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-7207
Practice Address - Country:US
Practice Address - Phone:706-817-5133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-30
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251B00000XAgenciesCase Management