Provider Demographics
NPI:1922751197
Name:HARRISON, CHARITY M
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:M
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 1:3860 FOUR POINTE FARMS LN APT 306
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43230-7659
Mailing Address - Country:US
Mailing Address - Phone:614-390-9684
Mailing Address - Fax:
Practice Address - Street 1:5969 E LIVINGSTON AVE STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-2907
Practice Address - Country:US
Practice Address - Phone:614-864-2700
Practice Address - Fax:614-864-2702
Is Sole Proprietor?:No
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2102983-TRNE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health