Provider Demographics
NPI:1275680274
Name:HARRELL, FLAVIA (LMFT)
Entity Type:Individual
Prefix:
First Name:FLAVIA
Middle Name:
Last Name:HARRELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 RIVER RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-4578
Mailing Address - Country:US
Mailing Address - Phone:706-322-3280
Mailing Address - Fax:706-322-2272
Practice Address - Street 1:5900 RIVER RD
Practice Address - Street 2:SUITE 301
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-4578
Practice Address - Country:US
Practice Address - Phone:706-322-3280
Practice Address - Fax:706-322-2272
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT000288106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1710085949Medicare UPIN
GA1518066331Medicare UPIN