Provider Demographics
NPI:1912608985
Name:HARRIS, MARK C (MA, CADC I, MAC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:C
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MA, CADC I, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 67826
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87193-7826
Mailing Address - Country:US
Mailing Address - Phone:541-337-7857
Mailing Address - Fax:
Practice Address - Street 1:4104 SKYVIEW CREST RD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5534
Practice Address - Country:US
Practice Address - Phone:541-337-7857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)