Provider Demographics
NPI:1518654979
Name:HARRIS, SHAKIRA ANGELIC (LMHP-R)
Entity Type:Individual
Prefix:
First Name:SHAKIRA
Middle Name:ANGELIC
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LMHP-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3602 WILMINGTON AVE APT C
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:23860-4653
Mailing Address - Country:US
Mailing Address - Phone:757-776-5423
Mailing Address - Fax:
Practice Address - Street 1:2405 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-7223
Practice Address - Country:US
Practice Address - Phone:804-643-0002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
VA0906012811104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health