Provider Demographics
NPI:1508218280
Name:HARRIS, AJILA (LCSW)
Entity Type:Individual
Prefix:
First Name:AJILA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11100 SEPULVEDA BLVD # 8-291
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1131
Mailing Address - Country:US
Mailing Address - Phone:747-253-1560
Mailing Address - Fax:516-714-9820
Practice Address - Street 1:11100 SEPULVEDA BLVD
Practice Address - Street 2:# 8-291
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1131
Practice Address - Country:US
Practice Address - Phone:747-253-1560
Practice Address - Fax:516-714-9820
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW718021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical