Provider Demographics
NPI:1245864198
Name:HARRISON, CONSTANCE M
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:M
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 1:13177 OAK KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:GEISMAR
Mailing Address - State:LA
Mailing Address - Zip Code:70734-3050
Mailing Address - Country:US
Mailing Address - Phone:225-620-4345
Mailing Address - Fax:
Practice Address - Street 1:17505 OLD JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3930
Practice Address - Country:US
Practice Address - Phone:985-500-3130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-01
Last Update Date:2020-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician