Provider Demographics
NPI:1336315159
Name:HARRIS, LINDA ROBERTSON (MA LPC NCC NCSC)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:ROBERTSON
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MA LPC NCC NCSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 BINGHAM AVENUE
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-9480
Mailing Address - Country:US
Mailing Address - Phone:336-712-4444
Mailing Address - Fax:336-712-4420
Practice Address - Street 1:6200 BINGHAM AVENUE
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-9480
Practice Address - Country:US
Practice Address - Phone:336-712-4444
Practice Address - Fax:336-712-4420
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC186101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool