Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 26739 | NY |
NPI | 1003450974 |
---|---|
Provider Name | Cheryll Harrison |
First Address | Newburgh, NY 12550-5306 |
Second Address | Newburgh, NY 12550-5306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2019 |
Last Update Date | 04/11/2019 |