Provider Demographics
NPI:1669087680
Name:HARRIS, KERRIE RENA (MA, LPC)
Entity type:Individual
Prefix:
First Name:KERRIE
Middle Name:RENA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 STONE ST
Mailing Address - Street 2:
Mailing Address - City:CULLODEN
Mailing Address - State:WV
Mailing Address - Zip Code:25510-9003
Mailing Address - Country:US
Mailing Address - Phone:304-654-7994
Mailing Address - Fax:
Practice Address - Street 1:16 LEON SULLIVAN WAY SUITE 300
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301
Practice Address - Country:UM
Practice Address - Phone:304-654-7994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2093101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional