Provider Demographics
NPI:1255882742
Name:HARRIS, ROBERT JOEL (LMSW)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOEL
Last Name:HARRIS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MARKET PLACE BLVD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30121-8718
Mailing Address - Country:US
Mailing Address - Phone:706-625-5900
Mailing Address - Fax:
Practice Address - Street 1:419 N WALL ST
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-1943
Practice Address - Country:US
Practice Address - Phone:706-659-7664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW007568101YM0800X
GACSW0075801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health