Healthcare Provider Details

I. General information

NPI: 1407072317
Provider Name (Legal Business Name): JOSEPH K HARRIS LAPC,NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BRAXTON CT
FAYETTEVILLE GA
30214-1968
US

IV. Provider business mailing address

486 N JEFF DAVIS DR
FAYETTEVILLE GA
30214-1664
US

V. Phone/Fax

Practice location:
  • Phone: 770-460-2460
  • Fax:
Mailing address:
  • Phone: 404-281-4948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC001151
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: