Healthcare Provider Details

I. General information

NPI: 1750248803
Provider Name (Legal Business Name): CHRISTINA HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 THACHER LOOP
ELGIN SC
29045-6405
US

IV. Provider business mailing address

219 THACHER LOOP
ELGIN SC
29045-6405
US

V. Phone/Fax

Practice location:
  • Phone: 719-210-6502
  • Fax:
Mailing address:
  • Phone: 719-210-6502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8669
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8669
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: