Provider Demographics
NPI:1750462370
Name:HARRISON, TOM HORSLEY (LMFT)
Entity type:Individual
Prefix:MR
First Name:TOM
Middle Name:HORSLEY
Last Name:HARRISON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 MINOR RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1629
Mailing Address - Country:US
Mailing Address - Phone:434-960-9915
Mailing Address - Fax:434-973-3237
Practice Address - Street 1:1501 MINOR RIDGE CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1629
Practice Address - Country:US
Practice Address - Phone:434-960-9915
Practice Address - Fax:434-973-3237
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717000570106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA08878MOtherSENTARA BEHAVIORAL HEALTH
VA188264OtherANTHEM BC BS