Provider Demographics
NPI:1912175258
Name:HARRIS, ANDREA T
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:T
Last Name:HARRIS
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:WARREN-YAZOO MENTAL HEALTH SERVICE
Mailing Address - Street 2:3444 WISCONSIN AVE.
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180
Mailing Address - Country:US
Mailing Address - Phone:601-638-0031
Mailing Address - Fax:
Practice Address - Street 1:WARREN-YAZOO MENTAL HEALTH SERVICE
Practice Address - Street 2:3444 WISCONSIN AVE.
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180
Practice Address - Country:US
Practice Address - Phone:601-638-0031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health