Healthcare Provider Details

I. General information

NPI: 1528477650
Provider Name (Legal Business Name): COLIN HARRIS III MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2014
Last Update Date: 10/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 BILTMORE AVE STE G276.10
ASHEVILLE NC
28801-4601
US

IV. Provider business mailing address

PO BOX 602373
CHARLOTTE NC
28260-2373
US

V. Phone/Fax

Practice location:
  • Phone: 828-213-4502
  • Fax:
Mailing address:
  • Phone: 828-213-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC009725
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberNLC.0103764
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: