Provider Demographics
NPI:1124701826
Name:HARRIS, BENJAMIN WILLIAM III (MA LPC)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:WILLIAM
Last Name:HARRIS
Suffix:III
Gender:M
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2924 EMERYWOOD PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-3746
Mailing Address - Country:US
Mailing Address - Phone:804-346-5165
Mailing Address - Fax:
Practice Address - Street 1:2924 EMERYWOOD PKWY STE 200
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-3746
Practice Address - Country:US
Practice Address - Phone:804-346-5165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701012753101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health