Provider Demographics
NPI:1164715678
Name:HARRIS, CAROL ANN (LPCS)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 S MAIN ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657-7881
Mailing Address - Country:US
Mailing Address - Phone:409-200-2220
Mailing Address - Fax:409-440-3344
Practice Address - Street 1:156 S MAIN ST
Practice Address - Street 2:SUITE 130
Practice Address - City:LUMBERTON
Practice Address - State:TX
Practice Address - Zip Code:77657-7881
Practice Address - Country:US
Practice Address - Phone:409-200-2220
Practice Address - Fax:409-440-3344
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63891101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional