Provider Demographics
NPI:1366826026
Name:CURRY, LARISSA MORGAN (AUD)
Entity Type:Individual
Prefix:DR
First Name:LARISSA
Middle Name:MORGAN
Last Name:CURRY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:LARISSA
Other - Middle Name:MORGAN
Other - Last Name:HECKLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 MOYE BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834
Practice Address - Country:US
Practice Address - Phone:252-744-6104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006423231H00000X
NC12614231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC19SQAOtherBCBS OF NC
NC1366826026Medicaid
NCQ58089AOtherMEDICARE