Healthcare Provider Details

I. General information

NPI: 1700343019
Provider Name (Legal Business Name): ROBERT ANTHONY HARRIS LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2019
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8114 FENWICK CT
LAUREL MD
20707-5612
US

IV. Provider business mailing address

8114 FENWICK CT
LAUREL MD
20707-5612
US

V. Phone/Fax

Practice location:
  • Phone: 908-331-1306
  • Fax:
Mailing address:
  • Phone: 908-331-1306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPRC15460
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: