Provider Demographics
NPI:1013663525
Name:HARRIS-CALLOWAY, CONSTANCE ROYAL (PROVIDER)
Entity Type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:ROYAL
Last Name:HARRIS-CALLOWAY
Suffix:
Gender:F
Credentials:PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 NW 28TH TER
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-3334
Mailing Address - Country:US
Mailing Address - Phone:195-491-4203
Mailing Address - Fax:
Practice Address - Street 1:3800 INVERRARY BLVD
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-4382
Practice Address - Country:US
Practice Address - Phone:954-445-8412
Practice Address - Fax:754-701-0328
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services