Provider Demographics
NPI:1639413420
Name:HARRIS, JOSEPH ROBERT JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ROBERT
Last Name:HARRIS
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HILLCREST SQ STE J
Mailing Address - Street 2:P. O. BOX 686
Mailing Address - City:LAURENS
Mailing Address - State:SC
Mailing Address - Zip Code:29360-2355
Mailing Address - Country:US
Mailing Address - Phone:864-984-2518
Mailing Address - Fax:864-984-6037
Practice Address - Street 1:100 HILLCREST SQ STE J
Practice Address - Street 2:
Practice Address - City:LAURENS
Practice Address - State:SC
Practice Address - Zip Code:29360-2355
Practice Address - Country:US
Practice Address - Phone:864-984-2518
Practice Address - Fax:864-984-6037
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC311103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCWP9984Medicaid