Provider Demographics
NPI:1023425105
Name:HARRIS, DADRON DEON (PHD)
Entity type:Individual
Prefix:MISS
First Name:DADRON
Middle Name:DEON
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 OAKLEAF LN
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-2927
Mailing Address - Country:US
Mailing Address - Phone:404-955-0562
Mailing Address - Fax:
Practice Address - Street 1:670 THORNTON WAY STE A
Practice Address - Street 2:
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-2608
Practice Address - Country:US
Practice Address - Phone:404-375-2694
Practice Address - Fax:877-743-3508
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X, 103TP2701X, 106H00000X, 171M00000X, 251S00000X
GA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003174290AMedicaid