Provider Demographics
NPI:1598108664
Name:HARRIS, GEORGE BRIAN (LCAS-A, LPCA)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:BRIAN
Last Name:HARRIS
Suffix:
Gender:M
Credentials:LCAS-A, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2812 MOBLEYS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GRIMESLAND
Mailing Address - State:NC
Mailing Address - Zip Code:27837-8832
Mailing Address - Country:US
Mailing Address - Phone:252-321-7381
Mailing Address - Fax:
Practice Address - Street 1:2812 MOBLEYS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:GRIMESLAND
Practice Address - State:NC
Practice Address - Zip Code:27837-8832
Practice Address - Country:US
Practice Address - Phone:252-321-7381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3249-A101YA0400X
NCA10188101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)