Healthcare Provider Details

I. General information

NPI: 1245708460
Provider Name (Legal Business Name): STACEY REID HARRIS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2018
Last Update Date: 11/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 NEW POINT RD STE 3201
WILLIAMSBURG VA
23188-9423
US

IV. Provider business mailing address

127 JORDANS JOURNEY
WILLIAMSBURG VA
23185-1444
US

V. Phone/Fax

Practice location:
  • Phone: 757-645-3558
  • Fax: 757-645-3668
Mailing address:
  • Phone: 757-262-8828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701003146
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: