Provider Demographics
NPI:1902917461
Name:HARRIS, KIMBERLY DUNBAR (MS)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DUNBAR
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 BRICKYARD CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-0841
Mailing Address - Country:US
Mailing Address - Phone:252-752-6266
Mailing Address - Fax:
Practice Address - Street 1:625 LYNNDALE CT
Practice Address - Street 2:SUITE B
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5463
Practice Address - Country:US
Practice Address - Phone:252-902-6481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5404101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional