Healthcare Provider Details

I. General information

NPI: 1447079819
Provider Name (Legal Business Name): JENNIFER HARRIS LCSW-A, LCAS, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19902 N COVE RD
CORNELIUS NC
28031-6571
US

IV. Provider business mailing address

7796 OLD POST RD
DENVER NC
28037-8277
US

V. Phone/Fax

Practice location:
  • Phone: 704-584-4111
  • Fax:
Mailing address:
  • Phone: 980-395-3117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP021234
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number29964
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: