Healthcare Provider Details

I. General information

NPI: 1053795799
Provider Name (Legal Business Name): LORITA HARRIS ED. D., LPC, NSCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2015
Last Update Date: 07/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1268 MEMORIAL DR
CLEVELAND MS
38732-9545
US

IV. Provider business mailing address

1268 MEMORIAL DR
CLEVELAND MS
38732-9545
US

V. Phone/Fax

Practice location:
  • Phone: 662-719-1202
  • Fax:
Mailing address:
  • Phone: 662-719-1202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1159
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1159
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1159
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number1159
License Number StateMS
# 5
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1159
License Number StateMS
# 6
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number1159
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: