Provider Demographics
NPI:1124843339
Name:HARRIS, MARTHA H
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:H
Last Name:HARRIS
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 1:303 SUMMERFIELD PL
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-7390
Mailing Address - Country:US
Mailing Address - Phone:256-366-4203
Mailing Address - Fax:
Practice Address - Street 1:303 SUMMERFIELD PL
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-7390
Practice Address - Country:US
Practice Address - Phone:256-366-4203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral