Provider Demographics
NPI:1902048838
Name:HARRIS, JILL L (LCAS)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:L
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 NAVAHO DR
Mailing Address - Street 2:SUITE 125
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7319
Mailing Address - Country:US
Mailing Address - Phone:919-431-9874
Mailing Address - Fax:919-550-9438
Practice Address - Street 1:1100 NAVAHO DR
Practice Address - Street 2:SUITE 125
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7319
Practice Address - Country:US
Practice Address - Phone:919-431-9874
Practice Address - Fax:919-550-9438
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1394101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)