Provider Demographics
NPI:1285298497
Name:HARRIS, CHRISTINE NICOLE (LCAS)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:NICOLE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 LUBBOCK DR
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-9637
Mailing Address - Country:US
Mailing Address - Phone:910-401-7886
Mailing Address - Fax:
Practice Address - Street 1:1224 BIGGS ST
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-5012
Practice Address - Country:US
Practice Address - Phone:910-291-0078
Practice Address - Fax:910-401-1809
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-24
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24270101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)