Provider Demographics
NPI:1669084638
Name:HARRIS, KEVON (LICSW)
Entity type:Individual
Prefix:
First Name:KEVON
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7521 BUCHANAN ST APT 7521-139
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784-2344
Mailing Address - Country:US
Mailing Address - Phone:773-450-9436
Mailing Address - Fax:
Practice Address - Street 1:530 COLLEGE ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20060-0001
Practice Address - Country:US
Practice Address - Phone:202-806-7651
Practice Address - Fax:202-806-9311
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26181104100000X
DCLC200002101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker