Provider Demographics
NPI:1528793445
Name:ANDERSON, HAROLD O JR
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:O
Last Name:ANDERSON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 MOORING CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-6747
Mailing Address - Country:US
Mailing Address - Phone:919-408-9615
Mailing Address - Fax:
Practice Address - Street 1:6 MOORING CT
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-6747
Practice Address - Country:US
Practice Address - Phone:919-408-9615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-24
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health