Provider Demographics
NPI:1568499127
Name:HARRISON, CHERYL ANN (LCSW, LPC)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LCSW, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2822 CASHWELL DR
Mailing Address - Street 2:#234
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-4302
Mailing Address - Country:US
Mailing Address - Phone:919-440-4024
Mailing Address - Fax:919-330-4248
Practice Address - Street 1:501 PATETOWN RD
Practice Address - Street 2:SUITE 17
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-8135
Practice Address - Country:US
Practice Address - Phone:919-440-4024
Practice Address - Fax:919-330-4248
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0034661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106155Medicaid
NC6106155Medicaid