Provider Demographics
NPI:1235884891
Name:HARRIS, TYWANIA LANIECE (MSW)
Entity Type:Individual
Prefix:MS
First Name:TYWANIA
Middle Name:LANIECE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 MICHELLE CT
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-0016
Mailing Address - Country:US
Mailing Address - Phone:313-409-6253
Mailing Address - Fax:
Practice Address - Street 1:1310 RAEFORD RD STE 2
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5086
Practice Address - Country:US
Practice Address - Phone:910-485-6336
Practice Address - Fax:888-972-8390
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-12
Last Update Date:2022-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0168051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical