Kelly Marie Harris, MA/ED.S, LPC, NCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

11918 Issued in NC

Practice address

13815 Professional Center Dr Ste 100
Huntersville, NC 28078

Phone

(704) 384-1320

Fax

(704) 316-3138

NPI assigned

Jan 13, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southlake Center for Self Discovery

  • Clinical Social Worker
  • Davidson, NC
  • NPI 1366656910
  NPD (past)
• Southlake Counseling & Consulting

  • Clinical Social Worker
  • Davidson, NC
  • NPI 1194864975
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1452643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603670400000",
    "number": "1417313982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "704-384-1320",
            "fax_number": "704-316-3138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13815 PROFESSIONAL CENTER DR STE 100",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "28078",
            "telephone_number": "704-384-1320",
            "fax_number": "704-316-3138"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "903 Northeast Dr",
            "address_2": "Suite 201",
            "address_purpose": "LOCATION",
            "city": "Davidson",
            "state": "NC",
            "postal_code": "28036",
            "country_code": "US",
            "telephone_number": "704-896-7776",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "769 N Wendover Rd",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "28211",
            "country_code": "US",
            "telephone_number": "704-376-7180",
            "fax_number": "704-531-9266",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "769 N Wendover Rd",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "28211",
            "country_code": "US",
            "telephone_number": "704-376-7180",
            "fax_number": "704-531-9266",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "KELLY",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "MA/ED.S, LPC, NCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-13",
        "last_updated": "2020-10-26",
        "certification_date": "2020-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "11918",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "11918",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kharris704732@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "903 Northeast Dr",
            "address_2": "Suite 201",
            "city": "Davidson",
            "state": "NC",
            "country_code": "US",
            "postal_code": "28036",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Carin Lynn Harris, OTR
• Denzil Andy Harris, MD
• Erica Brooke Harris
• Gwendolyn Dione Harris, LPCA
• Jennifer Lepors Harris, NP
• Kira Harris, PHARMD
• Obeghaenre Ochuko Harris, FNP-C
• Patricia Covington Harris, P.A.-C
• Christina Marie Harrison, AGNP-BC
• Scarlett Louise Harrison, MSW, LCSW

• Professional Counselor in Huntersville, NC
• Providers in Huntersville, NC by specialty
• Professional Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.