Provider Demographics
NPI:1275979148
Name:HARRIS, STACY FAWN
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:FAWN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6424 ARLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94805-1606
Mailing Address - Country:US
Mailing Address - Phone:925-594-0992
Mailing Address - Fax:
Practice Address - Street 1:2118 WILLOW PASS RD
Practice Address - Street 2:SUITE 500
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2408
Practice Address - Country:US
Practice Address - Phone:925-594-0992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor