Provider Demographics
NPI:1700859121
Name:HARBOUR, MARTHA LEIGH (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:LEIGH
Last Name:HARBOUR
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4808 METCALF DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-5619
Mailing Address - Country:US
Mailing Address - Phone:919-747-9895
Mailing Address - Fax:
Practice Address - Street 1:4808 METCALF DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-5619
Practice Address - Country:US
Practice Address - Phone:919-747-9895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2009-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0009231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC105723OtherUNITED BEHAVIORAL
NC39129OtherBLUE CROSS BLUE SHIELD
NC105723OtherUNITED BEHAVIORAL