Provider Demographics
NPI:1679270805
Name:HARRIS, DEMYCHAL
Entity type:Individual
Prefix:
First Name:DEMYCHAL
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6348 ARABIA RD
Mailing Address - Street 2:
Mailing Address - City:LUMBER BRIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:28357-8812
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:875 RAYS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:WHISPERING PINES
Practice Address - State:NC
Practice Address - Zip Code:28327-5910
Practice Address - Country:US
Practice Address - Phone:888-392-8642
Practice Address - Fax:888-783-7611
Is Sole Proprietor?:No
Enumeration Date:2023-02-08
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst