Provider Demographics
NPI:1467232538
Name:HARRIS, LUVENIA A
Entity Type:Individual
Prefix:
First Name:LUVENIA
Middle Name:A
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 1:2612 LEGACY WALK CT
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-7833
Mailing Address - Country:US
Mailing Address - Phone:678-231-3378
Mailing Address - Fax:
Practice Address - Street 1:2612 LEGACY WALK CT
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017-7833
Practice Address - Country:US
Practice Address - Phone:678-231-3378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-23-296953106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician