Provider Demographics
NPI:1710874649
Name:HARRISON, DARRYL FLOYD (LCSW A)
Entity type:Individual
Prefix:MR
First Name:DARRYL
Middle Name:FLOYD
Last Name:HARRISON
Suffix:
Gender:M
Credentials:LCSW A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9119 INVERNESS BAY RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-6729
Mailing Address - Country:US
Mailing Address - Phone:646-975-1511
Mailing Address - Fax:
Practice Address - Street 1:3301 TENNESSEE AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-4077
Practice Address - Country:US
Practice Address - Phone:646-975-1511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30214101YA0400X
NCP022057101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)