Provider Demographics
NPI:1740019835
Name:HARRIS, ANNIE OLIVIA (ACSW)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:OLIVIA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34494 RUNNING CANYON DR
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-1145
Mailing Address - Country:US
Mailing Address - Phone:310-936-7474
Mailing Address - Fax:
Practice Address - Street 1:34494 RUNNING CANYON DR
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-1145
Practice Address - Country:US
Practice Address - Phone:310-936-7474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305728101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional