MEDICARE: MRS. VICTORIA FENNER HARRIS LCSWA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	P014833	NC

General Provider Information

NPI Number	:	1104441575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VICTORIA FENNER HARRIS LCSWA

Provider Business Mailing Address
First Line	:	241 BRISK DR
Second Line	:
City	:	ZEBULON
State	:	NC
Zip	:	27597-5535
Country	:	US
Telephone Number	:	252-886-3176
Fax Number	:

Provider Business Practice Location Address
First Line	:	262 SOUTHTOWN CIR
Second Line	:
City	:	ROLESVILLE
State	:	NC
Zip	:	27571-9593
Country	:	US
Telephone Number	:	252-886-3176
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2020
Last Update Date	:	08/15/2022

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