Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | GA | |
N | 101YP1600X | Pastoral Counselor | ||
N | 103TP2701X | Group Psychotherapist |
NPI | 1023425105 |
---|---|
Provider Name | Miss Dadron Deon Harris |
First Address | Lithia Springs, GA 30122-2927 |
Second Address | Lithia Springs, GA 30122-2608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2014 |
Last Update Date | 24/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003174290A | (05) | GA |