Provider Demographics
NPI:1457841264
Name:HARRIS, SHINIQUA PRYOR (LCSWA)
Entity Type:Individual
Prefix:
First Name:SHINIQUA
Middle Name:PRYOR
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:SHINIQUA
Other - Middle Name:L
Other - Last Name:PRYOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5001 LONITA ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-2612
Mailing Address - Country:US
Mailing Address - Phone:336-338-0306
Mailing Address - Fax:
Practice Address - Street 1:301 E WENDOVER AVE STE 400
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1207
Practice Address - Country:US
Practice Address - Phone:336-832-3150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0122201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical