Healthcare Provider Details

I. General information

NPI: 1588627285
Provider Name (Legal Business Name): DWIGHT H. HARRO LMFT, MAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 04/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 24TH ST DEPARTMENT OF THE ARMY USA MEDDAC ATTN: MCXO-ASAP
FORT LEE VA
23801-1716
US

IV. Provider business mailing address

3540 HEMLOCK RD
CHESTER VA
23831-1809
US

V. Phone/Fax

Practice location:
  • Phone: 804-734-9942
  • Fax: 804-874-1008
Mailing address:
  • Phone: 910-580-2951
  • Fax: 804-734-9193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number620
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: