Healthcare Provider Details

I. General information

NPI: 1710595285
Provider Name (Legal Business Name): DIANA RAQUEL MORRISON M.ED., LCMHCA, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 CANAL DR
KILL DEVIL HILLS NC
27948-8428
US

IV. Provider business mailing address

721 CANAL DR
KILL DEVIL HILLS NC
27948-8428
US

V. Phone/Fax

Practice location:
  • Phone: 252-513-0502
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA15752
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: