Provider Demographics
NPI:1790137750
Name:HARRISON, CHARVELLE DIONNE
Entity Type:Individual
Prefix:MS
First Name:CHARVELLE
Middle Name:DIONNE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 PIRATES COVE RD
Mailing Address - Street 2:2042
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-4290
Mailing Address - Country:US
Mailing Address - Phone:702-488-4058
Mailing Address - Fax:
Practice Address - Street 1:7300 PIRATES COVE RD
Practice Address - Street 2:2042
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-4290
Practice Address - Country:US
Practice Address - Phone:702-488-4058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-01
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator