Provider Demographics
NPI:1124669890
Name:HARKINS, GENEVA CONSTANCE OLGA
Entity type:Individual
Prefix:MRS
First Name:GENEVA
Middle Name:CONSTANCE OLGA
Last Name:HARKINS
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 1:3900 TALLWOOD DR APT 612
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-7508
Mailing Address - Country:US
Mailing Address - Phone:207-479-1897
Mailing Address - Fax:
Practice Address - Street 1:3900 TALLWOOD DR APT 612
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-7508
Practice Address - Country:US
Practice Address - Phone:207-479-1897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst