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General NPI Number Information
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NPI Number | 1477199057
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Entity Type | Individual
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Provider Name | KELLY M HARRIS LPC, NCC
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Gender | Female
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Dates
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Enumeration Date | 11/19/2019
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Last Update Date | 11/20/2019
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Provider Practice Location Address
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Address Line | 2531 BRIARCLIFF RD NE STE 203
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City | ATLANTA
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State | GA
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Zip | 30329-3017
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Country | US
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Telephone | 678-849-4777
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Fax |
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Provider Business Mailing Address
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Address Line | 2218 RUGBY AVE
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City | COLLEGE PARK
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State | GA
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Zip | 30337-1019
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Country | US
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Telephone | 678-849-4777
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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 | LPC009410
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License Number State | GA
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