Healthcare Provider Details

I. General information

NPI: 1366768608
Provider Name (Legal Business Name): ROSHUN J HARRIS MA, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2010
Last Update Date: 07/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 LORD BALTIMORE DR SUITE A102
WINDSOR MILL MD
21244-2673
US

IV. Provider business mailing address

2505 LORD BALTIMORE DR SUITE A102
WINDSOR MILL MD
21244-2673
US

V. Phone/Fax

Practice location:
  • Phone: 410-903-3178
  • Fax: 866-623-6129
Mailing address:
  • Phone: 410-903-3178
  • Fax: 866-623-6129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC3404
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: