Provider Demographics
NPI:1407308323
Name:HARRIS, CHRISTINE (BS)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4699 N STATE ROAD 7 STE P
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33319-5890
Mailing Address - Country:US
Mailing Address - Phone:954-234-2724
Mailing Address - Fax:954-302-1830
Practice Address - Street 1:4699 N STATE ROAD 7 STE P
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-5890
Practice Address - Country:US
Practice Address - Phone:954-234-2724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator