Provider Demographics
NPI:1790468601
Name:HARRIS, LAMAYA SHANECE (RBT)
Entity Type:Individual
Prefix:
First Name:LAMAYA
Middle Name:SHANECE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 ROPER MOUNTAIN RD STE A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4235
Mailing Address - Country:US
Mailing Address - Phone:864-248-0713
Mailing Address - Fax:
Practice Address - Street 1:440 ROPER MOUNTAIN RD STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4235
Practice Address - Country:US
Practice Address - Phone:864-248-0713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-23-277976106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician