Provider Demographics
NPI:1649784943
Name:HARRIS, MONICA LYNN (LBSW)
Entity type:Individual
Prefix:MS
First Name:MONICA
Middle Name:LYNN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:MS
Other - First Name:MONICA
Other - Middle Name:LYNN
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LBSW
Mailing Address - Street 1:7310 WOODWARD AVE # STUIT601
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3165
Mailing Address - Country:US
Mailing Address - Phone:313-896-1444
Mailing Address - Fax:
Practice Address - Street 1:7310 WOODWARD AVE # STUIT601
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3165
Practice Address - Country:US
Practice Address - Phone:313-896-1444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-22
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802083879104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker