Provider Demographics
NPI:1609467737
Name:HARRIS, JUSTICE (LGSW)
Entity Type:Individual
Prefix:
First Name:JUSTICE
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14603 LONDON LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-2576
Mailing Address - Country:US
Mailing Address - Phone:202-607-4976
Mailing Address - Fax:
Practice Address - Street 1:14603 LONDON LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-2576
Practice Address - Country:US
Practice Address - Phone:202-607-4976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG50083397101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health