Provider Demographics
NPI:1992108146
Name:POWELL-HARRISON, DEMETRIA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:DEMETRIA
Middle Name:
Last Name:POWELL-HARRISON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 DUNDAS CIR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-1615
Mailing Address - Country:US
Mailing Address - Phone:336-641-4945
Mailing Address - Fax:336-641-6193
Practice Address - Street 1:6 DUNDAS CIR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1615
Practice Address - Country:US
Practice Address - Phone:336-641-4945
Practice Address - Fax:336-641-6193
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0076681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical