Provider Demographics
NPI:1093173296
Name:HIAWATHA HARRIS, M.C., INC
Entity Type:Organization
Organization Name:HIAWATHA HARRIS, M.C., INC
Other - Org Name:PATHWAYS TO WELLNESS MEDICATION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:NEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BECTON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:925-520-0005
Mailing Address - Street 1:5674 STONERIDGE DR
Mailing Address - Street 2:SUITE 207
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-8500
Mailing Address - Country:US
Mailing Address - Phone:925-520-0005
Mailing Address - Fax:925-520-0010
Practice Address - Street 1:590 B ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-5004
Practice Address - Country:US
Practice Address - Phone:925-520-0005
Practice Address - Fax:925-520-0010
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HIAWATHA HARRIS, M.C., INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty