Provider Demographics
NPI:1447079819
Name:HARRIS, JENNIFER (LCSW-A, LCAS, CADC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LCSW-A, LCAS, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19902 N COVE RD
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-6571
Mailing Address - Country:US
Mailing Address - Phone:704-584-4111
Mailing Address - Fax:
Practice Address - Street 1:19902 N COVE RD
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-6571
Practice Address - Country:US
Practice Address - Phone:704-584-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-03
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29964101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty