Provider Demographics
NPI:1639150014
Name:HARRY, ELIZABETH (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:HARRY
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 1:225 W PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-5430
Mailing Address - Country:US
Mailing Address - Phone:910-986-0935
Mailing Address - Fax:910-715-2435
Practice Address - Street 1:225 W PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-5430
Practice Address - Country:US
Practice Address - Phone:910-986-0935
Practice Address - Fax:910-986-0935
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-11
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI053451041C0700X
NCC0060211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM41284755Medicaid
NM341327512Medicare ID - Type Unspecified