Provider Demographics
NPI:1770281552
Name:HARRISON, AMMARA MONIQUE
Entity type:Individual
Prefix:
First Name:AMMARA
Middle Name:MONIQUE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N DORT ST APT 6B
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-3080
Mailing Address - Country:US
Mailing Address - Phone:813-408-2892
Mailing Address - Fax:
Practice Address - Street 1:2963 GULF TO BAY BLVD STE 320
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-4286
Practice Address - Country:US
Practice Address - Phone:813-497-2159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker