Provider Demographics
NPI:1871944124
Name:PHARRIS, TELISA DAWN (MSW, LCSWA, LCASA)
Entity type:Individual
Prefix:
First Name:TELISA
Middle Name:DAWN
Last Name:PHARRIS
Suffix:
Gender:F
Credentials:MSW, LCSWA, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1872 SPIRALWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-0498
Mailing Address - Country:US
Mailing Address - Phone:910-988-3323
Mailing Address - Fax:
Practice Address - Street 1:1872 SPIRALWOOD DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-0498
Practice Address - Country:US
Practice Address - Phone:910-988-3323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP010233101YM0800X
NCC0113101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health