Basic Information
| Provider Information | |||||||||
| NPI: | 1144855511 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARRIS | ||||||||
| FirstName: | MAURCUS | ||||||||
| MiddleName: | I | ||||||||
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| Credential: | LCSWA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3100 GENLEE DR | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277041883 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5717231252 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2732 ANN ELIZABETH DR | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272156650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362295905 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2020 | ||||||||
| LastUpdateDate: | 03/06/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | P014302 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.