Healthcare Provider Details

I. General information

NPI: 1275700106
Provider Name (Legal Business Name): SYLVIA M HARRIS LGPC, CAC-AD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 06/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18702 MARY FLOWERS WAY
HAGERSTOWN MD
21740-1494
US

IV. Provider business mailing address

18702 MARY FLOWERS WAY
HAGERSTOWN MD
21740-1494
US

V. Phone/Fax

Practice location:
  • Phone: 301-991-2855
  • Fax:
Mailing address:
  • Phone: 301-991-2855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberAC1600
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP3340
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: