Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | MSW005852 | GA |
N | 1041S0200X | School Social Worker | 1267959 | GA |
NPI | 1003253642 |
---|---|
Provider Name | Ms. Janise Harris |
First Address | Mcdonough, GA 30253-8042 |
Second Address | Mcdonough, GA 30253-8042 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2013 |
Last Update Date | 22/05/2013 |