Provider Demographics
NPI:1093845562
Name:SAUNDRA WALKER HARRIS
Entity Type:Organization
Organization Name:SAUNDRA WALKER HARRIS
Other - Org Name:COUNSELING SERVICES OF MITCHELLVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAUNDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:310-583-1181
Mailing Address - Street 1:9701 APOLLO DR
Mailing Address - Street 2:SUITE 391
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774
Mailing Address - Country:US
Mailing Address - Phone:301-583-1181
Mailing Address - Fax:301-583-1184
Practice Address - Street 1:9701 APOLLO DR
Practice Address - Street 2:SUITE 391
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774
Practice Address - Country:US
Practice Address - Phone:301-583-1181
Practice Address - Fax:301-583-1184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03452101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG02160Medicare PIN
DCG02160Medicare PIN