Jacqueline Harris, LCMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

16915 Issued in NC

Practice address

4708 Mallard Creek Dr
Greensboro, NC 27405-2782

Phone

(336) 707-9677

NPI assigned

Mar 29, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Ms. Jacqueline Wells Former name

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1585440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730851200000",
    "number": "1730717448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4708 MALLARD CREEK DR",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274052782",
            "telephone_number": "336-707-9677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4708 MALLARD CREEK DR",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274052782",
            "telephone_number": "336-707-9677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "JACQUELINE",
        "credential": "LCMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-03-29",
        "last_updated": "2024-11-06",
        "certification_date": "2024-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "LCAS-2686",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "16915",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "WELLS",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Courtney Harris, LPCA
• Diannah Carol Harris, MA, LCMHC,LCASA,CCTP
• Fatima Laquita Harris
• Florendia L. Harris
• Ian Winfred Harris, PTA
• Jerry Wayne Harris, DPM
• Kathy M Harris, NP
• Kenneth Ray Harris
• Kristie Harris
• Laura Wade Harris

• Mental Health Counselor in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.