Provider Demographics
NPI:1295361673
Name:HARRIS, D'ANTHONY TEON
Entity Type:Individual
Prefix:
First Name:D'ANTHONY
Middle Name:TEON
Last Name:HARRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 DUPONT CT
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-5844
Mailing Address - Country:US
Mailing Address - Phone:478-918-4040
Mailing Address - Fax:
Practice Address - Street 1:1253 COMMERCIAL DR SW STE A
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-5987
Practice Address - Country:US
Practice Address - Phone:770-285-6049
Practice Address - Fax:470-207-7902
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-18
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011076101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional