Provider Demographics
NPI:1801031166
Name:HARRIS, MARTINA CAROLYN
Entity Type:Individual
Prefix:MS
First Name:MARTINA
Middle Name:CAROLYN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 CHEROKEE DR
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906-2327
Mailing Address - Country:US
Mailing Address - Phone:831-443-5264
Mailing Address - Fax:
Practice Address - Street 1:433 SALINAS ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-2717
Practice Address - Country:US
Practice Address - Phone:831-757-7915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-15
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health