Provider Demographics
NPI:1336424126
Name:HARRIS, TAMU NYAMAVA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TAMU
Middle Name:NYAMAVA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3633 SUNBIRD WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-3327
Mailing Address - Country:US
Mailing Address - Phone:619-517-7754
Mailing Address - Fax:
Practice Address - Street 1:3633 SUNBIRD WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92124-3327
Practice Address - Country:US
Practice Address - Phone:619-517-7754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical