Provider Demographics
NPI:1265135313
Name:HARRIS, COURTNEY MICHELLE (LCSW-C)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:MICHELLE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 POTOMAC RD
Mailing Address - Street 2:
Mailing Address - City:JOPPA
Mailing Address - State:MD
Mailing Address - Zip Code:21085-4825
Mailing Address - Country:US
Mailing Address - Phone:443-721-9956
Mailing Address - Fax:
Practice Address - Street 1:527 POTOMAC RD
Practice Address - Street 2:
Practice Address - City:JOPPA
Practice Address - State:MD
Practice Address - Zip Code:21085-4825
Practice Address - Country:US
Practice Address - Phone:443-721-9956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD296561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty