Provider Demographics
NPI:1932255775
Name:HARRIS, CLIFTON TB (PHD)
Entity Type:Individual
Prefix:
First Name:CLIFTON
Middle Name:TB
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 OAK PLZ
Mailing Address - Street 2:SUITE 209
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-3008
Mailing Address - Country:US
Mailing Address - Phone:828-253-0643
Mailing Address - Fax:828-253-7766
Practice Address - Street 1:1 OAK PLZ
Practice Address - Street 2:SUITE 209
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-3008
Practice Address - Country:US
Practice Address - Phone:828-253-0643
Practice Address - Fax:828-253-7766
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1511103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0365KOtherBCBS