=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689271074
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VANEECIA HARKINS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2020
-----------------------------------------------------
Last Update Date | 10/08/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1121 GREENWOOD XING STE 103
-----------------------------------------------------
City | BESSEMER
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35022-5687
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-364-2022
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4024 WOODRIDGE DR
-----------------------------------------------------
City | PLEASANT GROVE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35127-2638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------