Healthcare Provider Details

I. General information

NPI: 1891807236
Provider Name (Legal Business Name): STEPHANIE J HAYESHARRIS LPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 BROWN ST
WASHINGTON NC
27889-4671
US

IV. Provider business mailing address

8219 US HIGHWAY 264 E
WASHINGTON NC
27889-7794
US

V. Phone/Fax

Practice location:
  • Phone: 252-946-4134
  • Fax: 252-946-2432
Mailing address:
  • Phone: 252-946-4134
  • Fax: 252-946-2432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2337
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: