Provider Demographics
NPI:1639703101
Name:HARRISON, KIANA L
Entity Type:Individual
Prefix:
First Name:KIANA
Middle Name:L
Last Name:HARRISON
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 1:133 MASSACHUSETTS ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48203-3538
Mailing Address - Country:US
Mailing Address - Phone:313-443-2043
Mailing Address - Fax:
Practice Address - Street 1:133 MASSACHUSETTS ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:MI
Practice Address - Zip Code:48203-3538
Practice Address - Country:US
Practice Address - Phone:313-443-2043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical