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NPI Code Detail

MEDICARE: MRS. CHARLETT THERESA HARRIS LPC012133

MEDICARE: MRS. CHARLETT THERESA HARRIS LPC012133
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
1101YP2500XProfessional CounselorLPC012133GA

General Provider Information

NPI Number : 1720660855
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CHARLETT THERESA HARRIS LPC012133
Provider Business Mailing Address
First Line : 3911 MARY ELIZA TRCE NW STE 200
Second Line :
City : MARIETTA
State : GA
Zip : 30064-1088
Country : US
Telephone Number : 678-631-9907
Fax Number : 678-701-7909
Provider Business Practice Location Address
First Line : 3911 MARY ELIZA TRCE NW STE 200
Second Line :
City : MARIETTA
State : GA
Zip : 30064-1088
Country : US
Telephone Number : 678-631-9907
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2021
Last Update Date : 09/10/2024

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Directions to “ MRS. CHARLETT THERESA HARRIS LPC012133” Practice Location

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