Provider Demographics
NPI:1841686011
Name:HARRIS, LA VERNE JASMINE (CADC-CAS)
Entity type:Individual
Prefix:
First Name:LA VERNE
Middle Name:JASMINE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:CADC-CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 EMERALD CT
Mailing Address - Street 2:
Mailing Address - City:GALT
Mailing Address - State:CA
Mailing Address - Zip Code:95632-2306
Mailing Address - Country:US
Mailing Address - Phone:209-912-8233
Mailing Address - Fax:
Practice Address - Street 1:1513 SPORTS DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-1943
Practice Address - Country:US
Practice Address - Phone:916-575-8851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC034390315101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)