Healthcare Provider Details

I. General information

NPI: 1801405246
Provider Name (Legal Business Name): ARIEL HARRISON PH.D., LPC, LSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2020
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3185 PALM TREE DR
LITHONIA GA
30038-2362
US

IV. Provider business mailing address

3185 PALM TREE DR
LITHONIA GA
30038-2362
US

V. Phone/Fax

Practice location:
  • Phone: 470-309-3995
  • Fax:
Mailing address:
  • Phone: 470-309-3995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC010349
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number772112
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberPPS-0603625
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: