Provider Demographics
NPI:1932189107
Name:DEW, KATHLEEN MICHIE HARRISS (PH D)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:MICHIE HARRISS
Last Name:DEW
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5509B W FRIENDLY AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-4270
Mailing Address - Country:US
Mailing Address - Phone:336-272-0855
Mailing Address - Fax:336-272-9885
Practice Address - Street 1:5509B W FRIENDLY AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-4270
Practice Address - Country:US
Practice Address - Phone:336-272-0855
Practice Address - Fax:336-272-9885
Is Sole Proprietor?:No
Enumeration Date:2006-01-22
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1047103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2814881Medicare ID - Type UnspecifiedPSYCHOLOGIST