Provider Demographics
NPI:1356109326
Name:HARRIS, KAI-MCKENZIE (LMSW)
Entity type:Individual
Prefix:
First Name:KAI-MCKENZIE
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 HAYNES PARK PL
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-3571
Mailing Address - Country:US
Mailing Address - Phone:786-397-5970
Mailing Address - Fax:
Practice Address - Street 1:1093 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30344-6740
Practice Address - Country:US
Practice Address - Phone:404-768-2218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW010955104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker