Provider Demographics
NPI:1144319021
Name:HARRIS, CATHLEEN RENEE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CATHLEEN
Middle Name:RENEE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4415 MONROE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-7743
Mailing Address - Country:US
Mailing Address - Phone:704-332-3634
Mailing Address - Fax:704-366-9243
Practice Address - Street 1:4415 MONROE RD STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-7743
Practice Address - Country:US
Practice Address - Phone:704-332-3634
Practice Address - Fax:704-366-9243
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0049151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003176Medicaid