Healthcare Provider Details

I. General information

NPI: 1003377110
Provider Name (Legal Business Name): DANIEL HARRIS LCADC, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 DIVISION ST
BOONTON NJ
07005-1738
US

IV. Provider business mailing address

2945 HATCHERS RUN
LELAND NC
28451-2055
US

V. Phone/Fax

Practice location:
  • Phone: 973-267-6000
  • Fax:
Mailing address:
  • Phone: 973-267-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00292200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC00799400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: