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General NPI Number Information
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NPI Number | 1073248506
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Entity Type | Individual
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Provider Name | VERONICA HARRISON LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/19/2022
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Last Update Date | 08/08/2022
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Provider Practice Location Address
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Address Line | 15230 LAKESHORE DR
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City | CLEARLAKE
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State | CA
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Zip | 95422-8107
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Country | US
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Telephone | 707-995-4545
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1356
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City | SAN MARCOS
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State | CA
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Zip | 92079-1356
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 100277
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License Number State | CA
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