Provider Demographics
NPI:1700343019
Name:HARRIS, ROBERT ANTHONY (LGPC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ANTHONY
Last Name:HARRIS
Suffix:
Gender:M
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4313 28TH PL APT 3
Mailing Address - Street 2:
Mailing Address - City:MOUNT RAINIER
Mailing Address - State:MD
Mailing Address - Zip Code:20712-1530
Mailing Address - Country:US
Mailing Address - Phone:908-331-1306
Mailing Address - Fax:
Practice Address - Street 1:5300 BLAINE ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-6665
Practice Address - Country:US
Practice Address - Phone:202-398-6811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLGPC00340101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health