Provider Demographics
NPI:1346836848
Name:HARRIS, BRIANNA
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRII
Other - Middle Name:
Other - Last Name:YOUNG-HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21219 NAUTIQUE BLVD APT 301
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-6469
Mailing Address - Country:US
Mailing Address - Phone:704-402-9130
Mailing Address - Fax:
Practice Address - Street 1:21219 NAUTIQUE BLVD APT 301
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-6469
Practice Address - Country:US
Practice Address - Phone:704-402-9130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician