Provider Demographics
NPI:1598731325
Name:HARRIS, CORENA HITT (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CORENA
Middle Name:HITT
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 1:402 CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2458
Mailing Address - Country:US
Mailing Address - Phone:615-446-2134
Mailing Address - Fax:615-446-2866
Practice Address - Street 1:402 CENTER AVE
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2458
Practice Address - Country:US
Practice Address - Phone:615-446-2134
Practice Address - Fax:615-446-2866
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3065270OtherBLUE CROSS BLUE SHIELD
TN202102Medicaid
TN3065270OtherBLUE CROSS BLUE SHIELD