Provider Demographics
NPI:1295593846
Name:HARRIS, NICKIAH
Entity type:Individual
Prefix:
First Name:NICKIAH
Middle Name:
Last Name:HARRIS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 MAYO ST APT 3
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:TX
Mailing Address - Zip Code:75428-2976
Mailing Address - Country:US
Mailing Address - Phone:214-994-0230
Mailing Address - Fax:
Practice Address - Street 1:1111 W MOCKINGBIRD LN STE 1030
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-5028
Practice Address - Country:US
Practice Address - Phone:469-730-3284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-08
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No171M00000XOther Service ProvidersCase Manager/Care Coordinator