Provider Demographics
NPI:1427246545
Name:GOOD SAMARITAN COUNSEL PA
Entity type:Organization
Organization Name:GOOD SAMARITAN COUNSEL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIONNE
Authorized Official - Middle Name:D
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-358-8634
Mailing Address - Street 1:11725 BROADFIELD CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-4255
Mailing Address - Country:US
Mailing Address - Phone:919-358-8634
Mailing Address - Fax:
Practice Address - Street 1:5974 SIX FORKS RD
Practice Address - Street 2:TWIN FORKS OFFICE PLAZA
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-3896
Practice Address - Country:US
Practice Address - Phone:919-358-8634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC2005012132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty