Provider Demographics
NPI:1598231540
Name:HARRIS, MAYA T (LCMFT)
Entity Type:Individual
Prefix:MS
First Name:MAYA
Middle Name:T
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 SAINT JOHNS LN STE F
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2600
Mailing Address - Country:US
Mailing Address - Phone:240-776-2953
Mailing Address - Fax:
Practice Address - Street 1:3355 SAINT JOHNS LN STE F
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-2600
Practice Address - Country:US
Practice Address - Phone:240-776-2953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-17
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCM976106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist