Basic Information
| Provider Information | |||||||||
| NPI: | 1548771348 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARPER | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | ALLISON | ||||||||
| NamePrefix: | |||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24 CLAY ST | ||||||||
| Address2: | |||||||||
| City: | MARTINSVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 241122810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2766322108 | ||||||||
| FaxNumber: | 2766320995 | ||||||||
| Practice Location | |||||||||
| Address1: | 24 CLAY ST | ||||||||
| Address2: | |||||||||
| City: | MARTINSVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 241122810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2766322108 | ||||||||
| FaxNumber: | 2766320995 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2017 | ||||||||
| LastUpdateDate: | 10/19/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 0904010140 | VA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 1699754010 | 01 | VA | PIEDMONT REGIONAL COMMUNITY SERVICE BOARD | OTHER |