Provider Demographics
NPI:1841655974
Name:HARRIS, MARISSA JAYE (LPC)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:JAYE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:JAYE
Other - Last Name:GOULD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:100 CENTURY PARK SOUTH
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35226-3949
Mailing Address - Country:US
Mailing Address - Phone:205-565-6554
Mailing Address - Fax:888-386-9624
Practice Address - Street 1:100 CENTURY PARK SOUTH
Practice Address - Street 2:SUITE 102
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35226-3949
Practice Address - Country:US
Practice Address - Phone:205-565-6554
Practice Address - Fax:888-386-9624
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-16
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3414101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health