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NPI Code Detail

MEDICARE: LORETTA ANNETTE HARRIS

MEDICARE: LORETTA ANNETTE HARRIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorCRC1092SC

General Provider Information

NPI Number : 1437345576
Entity Type Code : Individual
Provider Name (Legal Business Name) : LORETTA ANNETTE HARRIS
Provider Business Mailing Address
First Line : 405 GREEN ROSE RD
Second Line :
City : COLUMBIA
State : SC
Zip : 29229-9102
Country : US
Telephone Number : 803-419-4241
Fax Number :
Provider Business Practice Location Address
First Line : 1823 GADSDEN ST
Second Line :
City : COLUMBIA
State : SC
Zip : 29201-2344
Country : US
Telephone Number : 803-779-5363
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2007
Last Update Date : 09/21/2007

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Directions to “ LORETTA ANNETTE HARRIS ” Practice Location

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