Healthcare Provider Details

I. General information

NPI: 1982258000
Provider Name (Legal Business Name): SHEA HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2019
Last Update Date: 01/19/2026
Certification Date: 01/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 COUNTY FARM RD
RIVERSIDE CA
92503-3508
US

IV. Provider business mailing address

10000 COUNTY FARM RD
RIVERSIDE CA
92503-3508
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-4400
  • Fax:
Mailing address:
  • Phone: 951-358-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number11214
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number130384
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: