Provider Demographics
NPI:1679504989
Name:HARRIS, KAREN PECK (MHDL)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:PECK
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MHDL
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:SUE
Other - Last Name:MARKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHDL
Mailing Address - Street 1:1120 PARK DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28147-6604
Mailing Address - Country:US
Mailing Address - Phone:704-638-0529
Mailing Address - Fax:
Practice Address - Street 1:608 MCCOMBS AVE
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-3605
Practice Address - Country:US
Practice Address - Phone:704-933-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3191101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1214QOtherBCBS PROVIDER ID