Basic Information
| Provider Information | |||||||||
| NPI: | 1457079741 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARBISON | ||||||||
| FirstName: | MONRIEL | ||||||||
| MiddleName: | JAMIKA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCMHC-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 486 SPAULDING RD | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287525212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286522919 | ||||||||
| FaxNumber: | 8286522981 | ||||||||
| Practice Location | |||||||||
| Address1: | 486 SPAULDING RD | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287525212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286522919 | ||||||||
| FaxNumber: | 8286522981 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2022 | ||||||||
| LastUpdateDate: | 08/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 07/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | A17981 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.