Provider Information for 1104208917
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Mrs. DESIRRAE ANDERSON-HARRIS LCSW
Sex: Female
NPI: 1104208917
Last Updated: 2022-08-17
Certification Date: 2022-08-17
Certification Date: 2022-08-17
Details
| Name | Value | ||||||||||||||
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| NPI | 1104208917 | ||||||||||||||
| Enumeration Date | 2015-06-29 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | YES | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 917 MICAHS WAY N SPRING LAKE, NC 28390-6001 United States Phone: 910-580-4357 | Fax:910-764-6726 | ||||||||||||||
| Primary Practice Address | 917 MICAHS WAY N SPRING LAKE, NC 28390-6001 United States Phone: 910-580-4357 | Fax:910-764-6726 | ||||||||||||||
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