Organization
TRI-CARE, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEBBIE N. HARRISON-CHURCH (PRACTICE MANAGER)
(336) 659-8301
Entity
Organization
Contact information
Practice address
1702 S HAWTHORNE RD, WINSTON SALEM, NC 27103-4016
(336) 659-8301
(336) 659-9361
Mailing address
1702 S HAWTHORNE RD, WINSTON SALEM, NC 27103-4016
(336) 659-8301
(336) 659-9361
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0204W
BLUECROSSBLUESHIELDGRP#
NC
Enumeration date
08/23/2006
Last updated
08/22/2020
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