Provider Demographics
NPI:1023428687
Name:HARRIS II, EUGENE (LCP, LCPC)
Entity type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:
Last Name:HARRIS II
Suffix:
Gender:M
Credentials:LCP, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4496 DODDS MILL DR
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-8193
Mailing Address - Country:US
Mailing Address - Phone:910-489-4014
Mailing Address - Fax:
Practice Address - Street 1:4496 DODDS MILL DR
Practice Address - Street 2:
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-8193
Practice Address - Country:US
Practice Address - Phone:910-489-4014
Practice Address - Fax:703-753-0405
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC7995101Y00000X
VA0701008614101YP2500X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty