Provider Demographics
NPI:1932340833
Name:HARRIS, TYNDALL PEACOCK (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:TYNDALL
Middle Name:PEACOCK
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PHD, LPC
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 447
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-0447
Mailing Address - Country:US
Mailing Address - Phone:919-933-3710
Mailing Address - Fax:
Practice Address - Street 1:307 N COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-2119
Practice Address - Country:US
Practice Address - Phone:919-933-3710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6782101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional