Provider Demographics
NPI:1710352471
Name:HARRIS, GREGORY
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9030 ROUTE 108
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-1990
Mailing Address - Country:US
Mailing Address - Phone:410-740-1901
Mailing Address - Fax:
Practice Address - Street 1:9030 ROUTE 108
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-1990
Practice Address - Country:US
Practice Address - Phone:410-740-1901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6471101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional