Provider Demographics
NPI:1659059681
Name:HARRIS, LA CHRISTIANA (MS)
Entity Type:Individual
Prefix:
First Name:LA CHRISTIANA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2971 SE 92ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-1429
Mailing Address - Country:US
Mailing Address - Phone:206-854-3695
Mailing Address - Fax:
Practice Address - Street 1:812 NE 28TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2409
Practice Address - Country:US
Practice Address - Phone:503-936-1924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program