Provider Demographics
NPI:1073931820
Name:POPE, HARRIS TODD (NCAC II, CCS)
Entity Type:Individual
Prefix:MR
First Name:HARRIS
Middle Name:TODD
Last Name:POPE
Suffix:
Gender:M
Credentials:NCAC II, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1143
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:GA
Mailing Address - Zip Code:30110-1143
Mailing Address - Country:US
Mailing Address - Phone:678-447-4289
Mailing Address - Fax:
Practice Address - Street 1:251 PRISM DR.
Practice Address - Street 2:SUITE 11
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30116-9349
Practice Address - Country:US
Practice Address - Phone:678-447-4289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YA0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health