Provider Demographics
NPI:1760021471
Name:PAYNE, HARRIETT ELIZABETH MOORE (LPCA)
Entity Type:Individual
Prefix:
First Name:HARRIETT
Middle Name:ELIZABETH MOORE
Last Name:PAYNE
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:MRS
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPCA
Mailing Address - Street 1:170 DAVIDSON HWY
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-4245
Mailing Address - Country:US
Mailing Address - Phone:980-209-6328
Mailing Address - Fax:
Practice Address - Street 1:170 DAVIDSON HWY STE 201
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-4255
Practice Address - Country:US
Practice Address - Phone:980-209-6328
Practice Address - Fax:704-298-4206
Is Sole Proprietor?:No
Enumeration Date:2019-12-27
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC948595101YS0200X
NCA14992101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA14992OtherBCBS, CIGNA, AETNA, UNITED HEALTHCARE