Individual
JACQUELINE HARRIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCMHC
Contact information
Practice address
4708 MALLARD CREEK DR, GREENSBORO, NC 27405-2782
(336) 707-9677
Mailing address
4708 MALLARD CREEK DR, GREENSBORO, NC 27405-2782
(336) 707-9677
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCAS-2686
NC
101YM0800X
Mental Health Counselor
Primary
16915
NC
101YM0800X
Mental Health Counselor
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Other
Enumeration date
03/29/2020
Last updated
11/06/2024
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