Provider Demographics
NPI:1295024750
Name:HARRIS, DENETTA V (MSW, LISW)
Entity Type:Individual
Prefix:
First Name:DENETTA
Middle Name:V
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 CONGRESS PARK DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4009
Mailing Address - Country:US
Mailing Address - Phone:937-907-1437
Mailing Address - Fax:937-741-4788
Practice Address - Street 1:955 CONGRESS PARK DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4009
Practice Address - Country:US
Practice Address - Phone:937-907-1437
Practice Address - Fax:937-741-4788
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.22040041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical