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General NPI Number Information
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NPI Number | 1750713368
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Entity Type | Individual
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Provider Name | FRANK DARRYL HARRIS LCSW, CADC
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Gender | Male
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Dates
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Enumeration Date | 08/06/2013
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Last Update Date | 07/28/2015
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Provider Practice Location Address
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Address Line | 5517 N KENMORE AVE
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City | CHICAGO
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State | IL
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Zip | 60640-1515
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Country | US
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Telephone | 773-275-7962
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Fax | 773-275-0728
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Provider Business Mailing Address
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Address Line | 411 N KENNETH CT
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City | GLENWOOD
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State | IL
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Zip | 60425-1205
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Country | US
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Telephone | 708-275-5886
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150.010429
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 21137
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License Number State | IL
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