MEDICARE: MRS. MANDY 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	P019649	NC

General Provider Information

NPI Number	:	1417810151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MANDY HARRIS LCSWA

Provider Business Mailing Address
First Line	:	1883 ANTIOCH RD NE
Second Line	:
City	:	PIKEVILLE
State	:	NC
Zip	:	27863-8964
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2820 MACGREGOR DOWNS RD
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-8438
Country	:	US
Telephone Number	:	252-606-4774
Fax Number	:

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

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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