Provider Demographics
NPI:1518115625
Name:HARRISON, NANCY DEMORY (PHD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:DEMORY
Last Name:HARRISON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:MILES
Other - Last Name:DEMORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:545 SOUTHLAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-3042
Mailing Address - Country:US
Mailing Address - Phone:804-741-7500
Mailing Address - Fax:804-741-7900
Practice Address - Street 1:9515 CATESBY LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-4453
Practice Address - Country:US
Practice Address - Phone:804-741-7500
Practice Address - Fax:804-741-7900
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001004103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0810001004OtherVA STATE MEDICAL LICENSE