Provider Demographics
NPI:1265899777
Name:HARRIS, DAVE (CDP, BA, NCAC II)
Entity type:Individual
Prefix:
First Name:DAVE
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:CDP, BA, NCAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S 317TH ST
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5218
Mailing Address - Country:US
Mailing Address - Phone:253-841-8165
Mailing Address - Fax:253-841-8168
Practice Address - Street 1:719 E MAIN STE C
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3306
Practice Address - Country:US
Practice Address - Phone:253-740-4067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00002706101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)