Basic Information
Provider Information | |||||||||
NPI: | 1427129360 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HARRISON | ||||||||
FirstName: | LENNA | ||||||||
MiddleName: | LYALL | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | LCSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 895 STATE FARM RD | ||||||||
Address2: | SUITE 508 | ||||||||
City: | BOONE | ||||||||
State: | NC | ||||||||
PostalCode: | 286074917 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8282649007 | ||||||||
FaxNumber: | 8282625687 | ||||||||
Practice Location | |||||||||
Address1: | 1430 WILLOW LN | ||||||||
Address2: | WEST PARK C61-2 | ||||||||
City: | NORTH WILKESBORO | ||||||||
State: | NC | ||||||||
PostalCode: | 286593551 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3366675151 | ||||||||
FaxNumber: | 8282625687 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/13/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | C002730 | NC | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.