Provider Demographics
NPI:1972977312
Name:HARRIS, SANDRA (BS,MS,LPC,BCPC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:BS,MS,LPC,BCPC
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:17238 SUNDERLAND RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-4201
Mailing Address - Country:US
Mailing Address - Phone:313-282-3974
Mailing Address - Fax:
Practice Address - Street 1:17238 SUNDERLAND RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-4201
Practice Address - Country:US
Practice Address - Phone:313-282-3974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-23
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009463101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional