Provider Demographics
NPI:1134365901
Name:HARLEY, CARI LYNN (MSSA, LISW, LCDCIII)
Entity type:Individual
Prefix:
First Name:CARI
Middle Name:LYNN
Last Name:HARLEY
Suffix:
Gender:F
Credentials:MSSA, LISW, LCDCIII
Other - Prefix:
Other - First Name:CARI
Other - Middle Name:LYNN
Other - Last Name:WAKEFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW,LCDCIII
Mailing Address - Street 1:650 JOEL DR
Mailing Address - Street 2:
Mailing Address - City:FORT CAMPBELL
Mailing Address - State:KY
Mailing Address - Zip Code:42223-5318
Mailing Address - Country:US
Mailing Address - Phone:270-798-8388
Mailing Address - Fax:
Practice Address - Street 1:650 JOEL DR.
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223
Practice Address - Country:US
Practice Address - Phone:270-798-8388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.10001701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical