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General NPI Number Information
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NPI Number | 1154792323
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Entity Type | Organization
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Legal Business Name | CANDACE B. HARRIS, MSW, LCSW, PLLC
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Dates
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Enumeration Date | 10/14/2015
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Last Update Date | 02/29/2016
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Provider Practice Location Address
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Address Line | 3500 WESTGATE DR SUITE 504C
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City | DURHAM
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State | NC
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Zip | 27707-2567
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Country | US
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Telephone | 919-972-9626
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Fax |
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Provider Business Mailing Address
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Address Line | 6 LOST TREE CT
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City | DURHAM
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State | NC
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Zip | 27703-7187
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Country | US
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Telephone | 919-972-9626
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | CANDACE B HARRIS
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Credential | LCSW
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Telephone | 919-972-9626
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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 | C009387
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License Number State | NC
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