Healthcare Provider Details

I. General information

NPI: 1851165807
Provider Name (Legal Business Name): RACHEL JUSTINE HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2023
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 FAIRMONT AVE
FAIRMONT WV
26554-2710
US

IV. Provider business mailing address

203 PLAINVIEW AVE
FAIRMONT WV
26554-1853
US

V. Phone/Fax

Practice location:
  • Phone: 681-404-6869
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW102316884
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: