Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1043634975 |
---|---|
Provider Name | Darrin Harris |
First Address | Gulfport, MS 39501-4520 |
Second Address | Gulfport, MS 39501-4520 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2014 |
Last Update Date | 12/02/2014 |