Provider Demographics
NPI:1689928905
Name:HARLESTON, JAMILA K (MA, LCAS)
Entity Type:Individual
Prefix:
First Name:JAMILA
Middle Name:K
Last Name:HARLESTON
Suffix:
Gender:F
Credentials:MA, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12543 JESSICA PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-1579
Mailing Address - Country:US
Mailing Address - Phone:704-726-0018
Mailing Address - Fax:
Practice Address - Street 1:12543 JESSICA PL
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-1579
Practice Address - Country:US
Practice Address - Phone:704-726-0018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-08
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2925-A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)