Provider Demographics
NPI:1578995593
Name:ROSHUN J HARRIS LCPC & ASSOCIATES LLC
Entity Type:Organization
Organization Name:ROSHUN J HARRIS LCPC & ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ROSHUN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC NCC
Authorized Official - Phone:410-903-3178
Mailing Address - Street 1:2505 LORD BALTIMORE DR
Mailing Address - Street 2:A-102
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2673
Mailing Address - Country:US
Mailing Address - Phone:410-903-3178
Mailing Address - Fax:410-510-1001
Practice Address - Street 1:17 WARREN RD
Practice Address - Street 2:SUITE 25A
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-5334
Practice Address - Country:US
Practice Address - Phone:410-903-3178
Practice Address - Fax:410-510-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3404101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDX9940001OtherCAREFIRST BCBS
MD3217788OtherCIGNA
MD030347000Medicaid