Provider Demographics
NPI:1790571537
Name:SEYMOUR, HARRY EDDIE
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:EDDIE
Last Name:SEYMOUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 690670
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-7012
Mailing Address - Country:US
Mailing Address - Phone:704-957-4722
Mailing Address - Fax:704-706-2629
Practice Address - Street 1:4700 LEBANON RD STE A3
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-8265
Practice Address - Country:US
Practice Address - Phone:704-957-4722
Practice Address - Fax:704-706-2629
Is Sole Proprietor?:No
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000000000103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral