Provider Demographics
NPI:1689422974
Name:HARRISON, JUSTIN C (CPRS)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:C
Last Name:HARRISON
Suffix:
Gender:M
Credentials:CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 TURTLE ROCK TRCE
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2812
Mailing Address - Country:US
Mailing Address - Phone:804-738-1784
Mailing Address - Fax:
Practice Address - Street 1:245 CHESAPEAKE AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23607-6038
Practice Address - Country:US
Practice Address - Phone:757-586-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility