Provider Demographics
NPI:1013942804
Name:HARRIS, ANNETTE C (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:C
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10478 FAIR OAKS
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-4141
Mailing Address - Country:US
Mailing Address - Phone:410-730-7783
Mailing Address - Fax:410-730-3042
Practice Address - Street 1:10478 FAIR OAKS
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-4141
Practice Address - Country:US
Practice Address - Phone:410-730-7783
Practice Address - Fax:410-730-3042
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD125531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical