Healthcare Provider Details

I. General information

NPI: 1134889504
Provider Name (Legal Business Name): JANEA HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2021
Last Update Date: 12/27/2021
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2585 CHIPPING CT
VILLA RICA GA
30180-5839
US

IV. Provider business mailing address

PO BOX 571
VILLA RICA GA
30180-0571
US

V. Phone/Fax

Practice location:
  • Phone: 770-568-8138
  • Fax:
Mailing address:
  • Phone: 177-056-8813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225600000X
TaxonomyDance Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: