Provider Demographics
NPI:1609302660
Name:HARRIS, ATHENA
Entity Type:Individual
Prefix:
First Name:ATHENA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2931 SW 87TH TER
Mailing Address - Street 2:UNIT 1903
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-6669
Mailing Address - Country:US
Mailing Address - Phone:404-341-8589
Mailing Address - Fax:
Practice Address - Street 1:2931 SW 87TH TER
Practice Address - Street 2:UNIT 1903
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-6669
Practice Address - Country:US
Practice Address - Phone:404-341-8589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst