MEDICARE: JOI 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
1	1041C0700X	Clinical Social Worker	094008086	VA

General Provider Information

NPI Number	:	1710308978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOI HARRIS

Provider Business Mailing Address
First Line	:	473 LEE'S MILL DR.
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23608
Country	:	US
Telephone Number	:	757-291-2696
Fax Number	:

Provider Business Practice Location Address
First Line	:	3221 COMMANDER SHEPARD BLVD
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-1598
Country	:	US
Telephone Number	:	757-244-3500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2013
Last Update Date	:	12/13/2013

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