Provider Demographics
NPI:1255444790
Name:HARRIS, QUIANDA NICHELLE (EDD, LPC-MHSP, MAC)
Entity type:Individual
Prefix:DR
First Name:QUIANDA
Middle Name:NICHELLE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:EDD, LPC-MHSP, MAC
Other - Prefix:
Other - First Name:QUIANDA
Other - Middle Name:NICHELLE
Other - Last Name:STANLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, CSAC
Mailing Address - Street 1:1211 21ST AVE S STE 10
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-2717
Mailing Address - Country:US
Mailing Address - Phone:615-936-1327
Mailing Address - Fax:615-936-3678
Practice Address - Street 1:1211 21ST AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2717
Practice Address - Country:US
Practice Address - Phone:615-936-1327
Practice Address - Fax:615-936-3678
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710101764101Y00000X
VA0701003705101YP2500X
TN101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1659424448Medicaid