Provider Demographics
NPI:1275204869
Name:HARRIS, DSHAWN (MED, LGPC)
Entity Type:Individual
Prefix:
First Name:DSHAWN
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MED, LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WARREN RD STE 5A
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-2429
Mailing Address - Country:US
Mailing Address - Phone:443-595-7627
Mailing Address - Fax:
Practice Address - Street 1:111 WARREN RD STE 5A
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-2429
Practice Address - Country:US
Practice Address - Phone:443-595-7627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP11925101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health