Provider Demographics
NPI:1508404997
Name:HARMON, PRIDGETT
Entity Type:Individual
Prefix:
First Name:PRIDGETT
Middle Name:
Last Name:HARMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 LIMESTONE CT
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-8636
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:410-443-0842
Practice Address - Street 1:2324 WEST ZION ROAD
Practice Address - Street 2:SUITE 112
Practice Address - City:SALISBURY MD
Practice Address - State:MD
Practice Address - Zip Code:21801
Practice Address - Country:US
Practice Address - Phone:800-867-2395
Practice Address - Fax:410-443-0842
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP10029101YM0800X, 101YP2500X
101YM0800X
MDLC12798101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health