Provider Demographics
NPI:1639348642
Name:HARRISON, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 SUGAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LEICESTER
Mailing Address - State:NC
Mailing Address - Zip Code:28748-5512
Mailing Address - Country:US
Mailing Address - Phone:828-350-1000
Mailing Address - Fax:828-350-1723
Practice Address - Street 1:457 SUGAR CREEK RD
Practice Address - Street 2:
Practice Address - City:LEICESTER
Practice Address - State:NC
Practice Address - Zip Code:28748-5512
Practice Address - Country:US
Practice Address - Phone:828-350-1000
Practice Address - Fax:828-350-1723
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-23
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4845101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6112059Medicaid