Provider Demographics
NPI:1467003640
Name:HARVEY, KNINA GENELLE (LCSWA)
Entity Type:Individual
Prefix:
First Name:KNINA
Middle Name:GENELLE
Last Name:HARVEY
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5018 RESERVOIR RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-5372
Mailing Address - Country:US
Mailing Address - Phone:919-706-9297
Mailing Address - Fax:
Practice Address - Street 1:801 WILLIFORD ST
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27803-3825
Practice Address - Country:US
Practice Address - Phone:252-451-8591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0137461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical