Provider Demographics
NPI:1619995891
Name:HARRISON, VIRGINIA HARPER (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:HARPER
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4283 PIEDMONT AVE
Mailing Address - Street 2:SUITE E-8
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-4713
Mailing Address - Country:US
Mailing Address - Phone:925-253-9480
Mailing Address - Fax:925-253-9480
Practice Address - Street 1:4283 PIEDMONT AVE
Practice Address - Street 2:SUITE E-8
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-4713
Practice Address - Country:US
Practice Address - Phone:925-253-9480
Practice Address - Fax:925-253-9480
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS36081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ48614ZOtherBLUE SHIELD
CAZZZ48614ZOtherBLUE SHIELD
CAQ53389Medicare UPIN