Provider Demographics
NPI:1669672598
Name:HARRIS, STEPHEN B (LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:B
Last Name:HARRIS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:STEVE
Other - Middle Name:
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1900 CENTURY PLACE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-4302
Mailing Address - Country:US
Mailing Address - Phone:404-321-4954
Mailing Address - Fax:404-321-1928
Practice Address - Street 1:1900 CENTURY PLACE
Practice Address - Street 2:SUITE 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-4302
Practice Address - Country:US
Practice Address - Phone:404-321-4954
Practice Address - Fax:404-321-1928
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0007671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R13007Medicare UPIN
80BBFWMMedicare PIN