Provider Demographics
NPI:1710133293
Name:HARRIS, DEBORAH FREEMAN (LPC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:FREEMAN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 91
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28053-0091
Mailing Address - Country:US
Mailing Address - Phone:704-865-8722
Mailing Address - Fax:704-865-8723
Practice Address - Street 1:429 S YORK ST
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-4035
Practice Address - Country:US
Practice Address - Phone:704-865-8722
Practice Address - Fax:704-865-8723
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7093101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104020Medicaid