Provider Demographics
NPI:1790022580
Name:HARRIS, CHARESE BROWN (LCPC)
Entity Type:Individual
Prefix:
First Name:CHARESE
Middle Name:BROWN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:CHARESE
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:3010 GRAND AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-2321
Mailing Address - Country:US
Mailing Address - Phone:847-377-8247
Mailing Address - Fax:
Practice Address - Street 1:3010 GRAND AVE FL 2
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-2321
Practice Address - Country:US
Practice Address - Phone:847-377-8247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.012039101Y00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor