Provider Demographics
NPI:1467104521
Name:HARVELL, DEDRA JOAN (MA, S/T)
Entity Type:Individual
Prefix:MRS
First Name:DEDRA
Middle Name:JOAN
Last Name:HARVELL
Suffix:
Gender:F
Credentials:MA, S/T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27653
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31221-7653
Mailing Address - Country:US
Mailing Address - Phone:478-254-0481
Mailing Address - Fax:478-254-9723
Practice Address - Street 1:611 N WAYNE ST
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2834
Practice Address - Country:US
Practice Address - Phone:478-254-0481
Practice Address - Fax:478-254-9723
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty