Provider Demographics
NPI:1114589975
Name:MORRIS, CHANNTERIA C
Entity type:Individual
Prefix:
First Name:CHANNTERIA
Middle Name:C
Last Name:MORRIS
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 1:21591 SW 113TH AVE APT 204
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33189-2744
Mailing Address - Country:US
Mailing Address - Phone:786-797-0399
Mailing Address - Fax:
Practice Address - Street 1:21591 SW 113TH AVE APT 204
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33189-2744
Practice Address - Country:US
Practice Address - Phone:786-797-0399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCBHCM101081OtherFLORIDA CERTIFICATION BOARD