Provider Demographics
NPI:1629264247
Name:HARRIS, FLORA
Entity Type:Individual
Prefix:
First Name:FLORA
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 1:10601 CORONET CT
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-8610
Mailing Address - Country:US
Mailing Address - Phone:310-701-5351
Mailing Address - Fax:
Practice Address - Street 1:10601 CORONET CT
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-8610
Practice Address - Country:US
Practice Address - Phone:310-701-5351
Practice Address - Fax:704-595-3595
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC52157106H00000X
225400000X
CA52157106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner