Provider Demographics
NPI:1376113332
Name:HARRIS, VIC D
Entity Type:Individual
Prefix:
First Name:VIC
Middle Name:D
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 1:1401 HUDSON LN STE 202
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-6032
Mailing Address - Country:US
Mailing Address - Phone:318-323-1300
Mailing Address - Fax:318-323-1400
Practice Address - Street 1:1401 HUDSON LN STE 202
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6032
Practice Address - Country:US
Practice Address - Phone:318-323-1300
Practice Address - Fax:318-323-1400
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator