Provider Demographics
NPI:1700209855
Name:HARRIS, AYANNA E (MA, LLPC)
Entity Type:Individual
Prefix:
First Name:AYANNA
Middle Name:E
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23810 MICHIGAN AVE
Mailing Address - Street 2:SUITE 202A
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1830
Mailing Address - Country:US
Mailing Address - Phone:989-714-4942
Mailing Address - Fax:
Practice Address - Street 1:23810 MICHIGAN AVE
Practice Address - Street 2:SUITE 202A
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1830
Practice Address - Country:US
Practice Address - Phone:989-714-4942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-26
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011186101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional