Provider Demographics
NPI:1255495008
Name:HARRIS, YVONNE (CAC-AD)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:CAC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7920 CRISFIELD HWY
Mailing Address - Street 2:
Mailing Address - City:WESTOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21871-3922
Mailing Address - Country:US
Mailing Address - Phone:443-523-1790
Mailing Address - Fax:410-651-3189
Practice Address - Street 1:7920 CRISFIELD HWY
Practice Address - Street 2:
Practice Address - City:WESTOVER
Practice Address - State:MD
Practice Address - Zip Code:21871-3922
Practice Address - Country:US
Practice Address - Phone:443-523-1790
Practice Address - Fax:410-651-3189
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC2016101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)