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General NPI Number Information
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NPI Number | 1194207720
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Entity Type | Individual
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Provider Name | PATRICIA RENE HARRIS LPC
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Gender | Female
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Dates
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Enumeration Date | 08/30/2018
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Last Update Date | 08/30/2018
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Provider Practice Location Address
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Address Line | 9390 FORD AVE STE 7B
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City | RICHMOND HILL
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State | GA
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Zip | 31324-6420
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Country | US
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Telephone | 912-658-7352
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Fax |
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Provider Business Mailing Address
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Address Line | 805 RUSHING ST
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City | RICHMOND HILL
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State | GA
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Zip | 31324-6445
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Country | US
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Telephone | 912-658-7352
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC005252
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License Number State | GA
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