Provider Demographics
NPI:1447369061
Name:HARRIS, RODNEY EUGENE (PHD, LPCS, NCC, ACS)
Entity type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:EUGENE
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PHD, LPCS, NCC, ACS
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 131
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27588-0131
Mailing Address - Country:US
Mailing Address - Phone:919-961-7458
Mailing Address - Fax:
Practice Address - Street 1:5809 DEPARTURE DR STE 106
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-1936
Practice Address - Country:US
Practice Address - Phone:919-961-7458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4578101YM0800X
NC0701005333101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC138ROOtherBLUE CROSS BLUE SHIELD
NC6102278Medicaid