Healthcare Provider Details

I. General information

NPI: 1831057041
Provider Name (Legal Business Name): KAMILLE MONIQUE HARRIS PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 TECHNOLOGY CT SE STE J
SMYRNA GA
30082-5237
US

IV. Provider business mailing address

4800 N SCOTTSDALE RD STE 2500
SCOTTSDALE AZ
85251-7630
US

V. Phone/Fax

Practice location:
  • Phone: 770-431-2354
  • Fax: 770-436-7143
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY004811
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: