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General NPI Number Information
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NPI Number | 1942637905
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Entity Type | Individual
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Provider Name | JACQUELYN HARRISON PH.D.
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Gender | Female
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Dates
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Enumeration Date | 10/04/2013
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Last Update Date | 10/04/2013
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Provider Practice Location Address
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Address Line | 1540 SUNDAY DR STE 200
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City | RALEIGH
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State | NC
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Zip | 27607-6000
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Country | US
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Telephone | 919-859-9040
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Fax | 919-859-9030
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Provider Business Mailing Address
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Address Line | 6637 KEYSTONE DR
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City | RALEIGH
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State | NC
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Zip | 27612-5209
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Country | US
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Telephone | 919-247-2906
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Fax | 800-213-8256
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 3729
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License Number State | NC
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