Provider Demographics
NPI:1275809360
Name:HARRIS, NICOLE J (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:J
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5951 FAIRINGTON FARMS LN
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-1545
Mailing Address - Country:US
Mailing Address - Phone:404-668-8714
Mailing Address - Fax:
Practice Address - Street 1:5951 FAIRINGTON FARMS LN
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-1545
Practice Address - Country:US
Practice Address - Phone:404-668-8714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-22
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical