Provider Demographics
NPI:1932699949
Name:HARRIS, NICOLE (EDD, LPC, LSATP)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:EDD, LPC, LSATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 MONTICELLO AVE STE 350
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-2529
Mailing Address - Country:US
Mailing Address - Phone:757-937-9915
Mailing Address - Fax:757-299-0833
Practice Address - Street 1:900 GRANBY ST STE 242
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-2577
Practice Address - Country:US
Practice Address - Phone:757-756-5290
Practice Address - Fax:757-299-0833
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-15
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710102618101YA0400X
101YM0800X
VA0701007656101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health