Provider Demographics
NPI:1245402452
Name:HARRIS, PATRICIA (BS,MBA, CACII)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:BS,MBA, CACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 E CROSSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-5816
Mailing Address - Country:US
Mailing Address - Phone:470-444-4280
Mailing Address - Fax:
Practice Address - Street 1:419 E CROSSVILLE RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-5816
Practice Address - Country:US
Practice Address - Phone:470-444-4280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAA1204A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)