Provider Demographics
NPI:1215726328
Name:HARRIS, LE'SHEA NYCOLLE
Entity type:Individual
Prefix:
First Name:LE'SHEA
Middle Name:NYCOLLE
Last Name:HARRIS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 ALABAMA AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-2677
Mailing Address - Country:US
Mailing Address - Phone:904-420-2304
Mailing Address - Fax:904-508-0173
Practice Address - Street 1:45 ALABAMA AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-2677
Practice Address - Country:US
Practice Address - Phone:904-420-2304
Practice Address - Fax:904-508-0173
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician