Individual
TEDDY A HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
99 TAVERN RD, MARTINSBURG, WV 25401-2890
(304) 263-7023
(304) 264-0508
Mailing address
PO BOX 1146, MARTINSBURG, WV 25402-1146
(304) 263-7023
(304) 264-0508
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CP00939221
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810000510
—
WV
Enumeration date
07/15/2005
Last updated
01/14/2021
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