Provider Demographics
NPI:1952651903
Name:HARRIS-ADEEYO, TRUDY JANE (LCAS, CCS)
Entity Type:Individual
Prefix:MS
First Name:TRUDY
Middle Name:JANE
Last Name:HARRIS-ADEEYO
Suffix:
Gender:F
Credentials:LCAS, CCS
Other - Prefix:MS
Other - First Name:TRUDY
Other - Middle Name:JANE
Other - Last Name:HARRIS-ADEEYO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCS
Mailing Address - Street 1:326 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-3718
Mailing Address - Country:US
Mailing Address - Phone:919-560-0502
Mailing Address - Fax:919-560-0504
Practice Address - Street 1:326 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-3718
Practice Address - Country:US
Practice Address - Phone:919-560-0502
Practice Address - Fax:919-560-0504
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC354101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)