Charly Marie Harris, LCAS

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

3047 Issued in NC

Practice address

129 W Main St
Yadkinville, NC 27055

Phone

(336) 677-3900

NPI assigned

Apr 5, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/16389/brand/1/csg/1/fhir/r4

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.

• Southern Family Medicine, Inc.

  • Community/Behavioral Health Agency
  • Mooresville, NC
  • NPI 1881144590
  NPD

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

{
    "created_epoch": "1333584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702944000000",
    "number": "1790041515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "129 W MAIN ST",
            "city": "YADKINVILLE",
            "state": "NC",
            "postal_code": "27055",
            "telephone_number": "336-677-3900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 W MAIN ST",
            "city": "YADKINVILLE",
            "state": "NC",
            "postal_code": "27055",
            "telephone_number": "336-677-3900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1430 Willow Ln",
            "address_2": "WEST PARK C61-2",
            "address_purpose": "LOCATION",
            "city": "North Wilkesboro",
            "state": "NC",
            "postal_code": "286593551",
            "country_code": "US",
            "telephone_number": "336-667-5151",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1170 Fairgrove Church Rd",
            "address_purpose": "LOCATION",
            "city": "Hickory",
            "state": "NC",
            "postal_code": "286029695",
            "country_code": "US",
            "telephone_number": "828-464-1172",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "CHARLY",
        "middle_name": "MARIE",
        "credential": "LCAS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-05",
        "last_updated": "2023-12-19",
        "certification_date": "2023-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "3047",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Courtney Guido, LCSW
• Cheryl Lynn Guinn, PTA
• Nicholas Leo Gullett, PHARMD
• H. Diane Jenkins, LLC
• Crystal Leigh Hamlin, RN
• Health Services Unlimited Inc.
• Healthstat- Unifi Yadkinville Plant 1
• Healthstat- Unifi Yadkinville Plant 5
• Lauren Reavis Heller, FNP-BC
• Shelly Johnson Hethcoat

• Addiction (Substance Use Disorder) Counselor in Yadkinville, NC
• Providers in Yadkinville, NC by specialty
• Addiction (Substance Use Disorder) Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2023; 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.