Provider Demographics
NPI:1164796991
Name:HARRIS, DIANNAH CAROL (MA, LCMHC,LCASA,CCTP)
Entity type:Individual
Prefix:MS
First Name:DIANNAH
Middle Name:CAROL
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MA, LCMHC,LCASA,CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 OLDE SALEM DR
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282-8737
Mailing Address - Country:US
Mailing Address - Phone:252-802-1946
Mailing Address - Fax:
Practice Address - Street 1:805 ROSS AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-2411
Practice Address - Country:US
Practice Address - Phone:252-802-1946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-24
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2812A101YA0400X
NC10617101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)