Provider Demographics
NPI:1184149098
Name:HARRIS, PAIGE CECILIA ALSTON (MSW, ASW)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:CECILIA ALSTON
Last Name:HARRIS
Suffix:
Gender:
Credentials:MSW, ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 710041
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92171-0041
Mailing Address - Country:US
Mailing Address - Phone:559-649-5374
Mailing Address - Fax:
Practice Address - Street 1:1551 E SHAW AVE STE 139
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-8025
Practice Address - Country:US
Practice Address - Phone:559-320-0490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-11
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 390200000X
CA1113171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program