Provider Demographics
NPI:1821237728
Name:HARRIS, STEVEN A (MS, LMFT, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:A
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MS, LMFT, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12662
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24027-2662
Mailing Address - Country:US
Mailing Address - Phone:540-816-7042
Mailing Address - Fax:877-513-7721
Practice Address - Street 1:1390 SOUTHSIDE DR
Practice Address - Street 2:SUITE 117
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-4748
Practice Address - Country:US
Practice Address - Phone:540-816-7042
Practice Address - Fax:877-513-7721
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-17
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001531101YP2500X
VA0717000898106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1821237728Medicaid