Provider Demographics
NPI:1891807236
Name:HAYESHARRIS, STEPHANIE J (LPA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:J
Last Name:HAYESHARRIS
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8219 US HIGHWAY 264 E
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-7794
Mailing Address - Country:US
Mailing Address - Phone:252-946-4134
Mailing Address - Fax:252-946-2432
Practice Address - Street 1:1206 BROWN ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-4671
Practice Address - Country:US
Practice Address - Phone:252-946-4134
Practice Address - Fax:252-946-2432
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2337103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC046F4OtherBCBS