Provider Demographics
NPI:1073034211
Name:HARLESS, PEGGY PATRICIA (MS MFT)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:PATRICIA
Last Name:HARLESS
Suffix:
Gender:F
Credentials:MS MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2423
Mailing Address - Country:US
Mailing Address - Phone:229-630-2521
Mailing Address - Fax:
Practice Address - Street 1:410 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2423
Practice Address - Country:US
Practice Address - Phone:229-630-2521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor