Provider Demographics
NPI:1538499603
Name:HARRIS, QUINTINA SHAMIKA (LCSW, MCAP)
Entity Type:Individual
Prefix:
First Name:QUINTINA
Middle Name:SHAMIKA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LCSW, MCAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4710 NE SAVANNAH RD
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-3746
Mailing Address - Country:US
Mailing Address - Phone:772-940-1533
Mailing Address - Fax:
Practice Address - Street 1:10542 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5603
Practice Address - Country:US
Practice Address - Phone:772-940-1533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3358101YA0400X
FL4059101Y00000X
FL19130101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor