Provider Demographics
NPI:1205615200
Name:HARRISON, GUADALUPE DEL ROCIO
Entity type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:DEL ROCIO
Last Name:HARRISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 MULBERRY WAY
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-5010
Mailing Address - Country:US
Mailing Address - Phone:912-777-2617
Mailing Address - Fax:
Practice Address - Street 1:711 ZITTEROUR DR
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-9269
Practice Address - Country:US
Practice Address - Phone:912-937-9599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician