Provider Demographics
NPI:1104493105
Name:HARRIS, JAMES JR (LGPC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:HARRIS
Suffix:JR
Gender:M
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3261 OLD WASHINGTON RD STE 3021
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3229
Mailing Address - Country:US
Mailing Address - Phone:301-205-5979
Mailing Address - Fax:
Practice Address - Street 1:3261 OLD WASHINGTON RD STE 3021
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3229
Practice Address - Country:US
Practice Address - Phone:301-205-5979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGPC11423101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional