Provider Demographics
NPI:1023861580
Name:HARRIS, DEONNA MONIQUE NICOLE (LMBT)
Entity type:Individual
Prefix:
First Name:DEONNA
Middle Name:MONIQUE NICOLE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4810 ARBOR RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-1661
Mailing Address - Country:US
Mailing Address - Phone:757-218-8629
Mailing Address - Fax:
Practice Address - Street 1:4810 ARBOR RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-1661
Practice Address - Country:US
Practice Address - Phone:757-218-8629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019018669225700000X
NC20884225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist