Provider Demographics
NPI:1871721084
Name:HARRIS, LILLIAN G (RN, BS)
Entity type:Individual
Prefix:MRS
First Name:LILLIAN
Middle Name:G
Last Name:HARRIS
Suffix:
Gender:F
Credentials:RN, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4252 HARBOR RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-8576
Mailing Address - Country:US
Mailing Address - Phone:336-697-5470
Mailing Address - Fax:336-697-5470
Practice Address - Street 1:2007 YANCEYVILLE ST # 66
Practice Address - Street 2:SUITE 209
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-5000
Practice Address - Country:US
Practice Address - Phone:336-691-1772
Practice Address - Fax:336-691-1772
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TH0100X
NC214499163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service