Healthcare Provider Details

I. General information

NPI: 1366848350
Provider Name (Legal Business Name): ROLANDIA HARRIS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2014
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49197 WIXOM TECH DR STE B
WIXOM MI
48393-3572
US

IV. Provider business mailing address

PO BOX 293
SAGINAW MI
48606-0293
US

V. Phone/Fax

Practice location:
  • Phone: 810-471-0343
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801109262
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: