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General NPI Number Information
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NPI Number | 1992387179
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Entity Type | Organization
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Legal Business Name | MARY H HARRELL PSYCHOLOGIST, PLLC
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Dates
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Enumeration Date | 04/27/2021
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Last Update Date | 04/27/2021
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Provider Practice Location Address
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Address Line | 15720 BRIXHAM HILL AVE STE 300
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City | CHARLOTTE
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State | NC
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Zip | 28277-4784
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Country | US
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Telephone | 803-802-7143
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Fax |
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Provider Business Mailing Address
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Address Line | 1031 GREGORY JON CT
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City | FORT MILL
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State | SC
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Zip | 29707-0091
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Country | US
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Telephone | 315-529-1013
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Fax |
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Authorized Official
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Title or Position | ORGANIZER/MEMPER
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Name | DR. MARY H HARRELL
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Credential | PHD
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Telephone | 315-529-1013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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