Provider Demographics
NPI:1013349406
Name:HARRISON, LAURICE DEROZAN (DR)
Entity Type:Individual
Prefix:MRS
First Name:LAURICE
Middle Name:DEROZAN
Last Name:HARRISON
Suffix:
Gender:F
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 S. BURNSIDE AVE
Mailing Address - Street 2:STE 203
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737
Mailing Address - Country:US
Mailing Address - Phone:225-647-9001
Mailing Address - Fax:225-647-9001
Practice Address - Street 1:214 S. BURNSIDE AVE
Practice Address - Street 2:STE 203
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737
Practice Address - Country:US
Practice Address - Phone:225-647-9001
Practice Address - Fax:225-647-9001
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4438101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional