Healthcare Provider Details

I. General information

NPI: 1124944400
Provider Name (Legal Business Name): JADA HARRISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5027 WRIGHTSVILLE AVE
WILMINGTON NC
28403-7046
US

IV. Provider business mailing address

385 DARLINGTON AVE UNIT 201
WILMINGTON NC
28403-1335
US

V. Phone/Fax

Practice location:
  • Phone: 888-815-5502
  • Fax:
Mailing address:
  • Phone: 888-815-5502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA23154
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: