Provider Demographics
NPI:1205011129
Name:HARRIS, BRANDI LYNN (LCMHCS, LCAS,CSI NCC)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:LYNN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LCMHCS, LCAS,CSI NCC
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:LYNN
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCMHCS, LCAS,CSI NCC
Mailing Address - Street 1:118 EBENEZER RD
Mailing Address - Street 2:
Mailing Address - City:OLD FORT
Mailing Address - State:NC
Mailing Address - Zip Code:28762-7846
Mailing Address - Country:US
Mailing Address - Phone:302-607-8661
Mailing Address - Fax:
Practice Address - Street 1:118 EBENEZER RD
Practice Address - Street 2:
Practice Address - City:OLD FORT
Practice Address - State:NC
Practice Address - Zip Code:28762-7846
Practice Address - Country:US
Practice Address - Phone:302-607-8661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health