Provider Demographics
NPI:1750713368
Name:HARRIS, FRANK DARRYL (LCSW, CADC)
Entity type:Individual
Prefix:MR
First Name:FRANK
Middle Name:DARRYL
Last Name:HARRIS
Suffix:
Gender:M
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 N KENNETH CT
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60425-1205
Mailing Address - Country:US
Mailing Address - Phone:708-275-5886
Mailing Address - Fax:
Practice Address - Street 1:5517 N KENMORE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-1515
Practice Address - Country:US
Practice Address - Phone:773-275-7962
Practice Address - Fax:773-275-0728
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.010429104100000X
IL21137101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)