Active NPI
Desirrae Anderson-Harris, LCSW
- Clinical Social Worker
- Spring Lake, NC
National Provider Identifier
1104208917
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- C10145
- Practice address
- 917 Micahs Way N
Spring Lake, NC 28390-6001 - Phone
- (910) 580-4357
- Fax
- (910) 764-6726
- NPI assigned
- Jun 29, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | P008677 | NC | |
| Clinical Social Worker | 1041C0700X | C10145 | NC | Primary |
Addresses
Primary practice location
917 Micahs Way N
Spring Lake, NC 28390-6001
Mailing address
917 Micahs Way N
Spring Lake, NC 28390-6001
Phone (910) 580-4357
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | a.desirrae@mindfultherapyserviceshelps.com | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C10145 | NC | MD | Clinical Social Worker |
| P008677 | NC | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1435536000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660694400000",
"number": "1104208917",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "917 MICAHS WAY N",
"city": "SPRING LAKE",
"state": "NC",
"postal_code": "283906001",
"telephone_number": "910-580-4357",
"fax_number": "910-764-6726"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "917 MICAHS WAY N",
"city": "SPRING LAKE",
"state": "NC",
"postal_code": "283906001",
"telephone_number": "910-580-4357",
"fax_number": "910-764-6726"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON-HARRIS",
"first_name": "DESIRRAE",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-06-29",
"last_updated": "2022-08-17",
"certification_date": "2022-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NC",
"license": "P008677",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Social Worker, Clinical",
"state": "NC",
"license": "C10145",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "a.desirrae@mindfultherapyserviceshelps.com",
"affiliation": "N",
"endpointDescription": "Secure Email",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Secure Email",
"address_1": "917 Micahs Way N",
"city": "Spring Lake",
"state": "NC",
"country_code": "US",
"postal_code": "283906001",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Spring Lake, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.