Provider Demographics
NPI:1245043033
Name:HARRIS, RAKIYA SURTARA (MSW, LSW)
Entity type:Individual
Prefix:
First Name:RAKIYA
Middle Name:SURTARA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 E TOWN ST STE 303
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-4659
Mailing Address - Country:US
Mailing Address - Phone:419-917-9918
Mailing Address - Fax:
Practice Address - Street 1:5050 BLAZER PKWY STE 100
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-3361
Practice Address - Country:US
Practice Address - Phone:888-830-0347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-28
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2309947104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker