Provider Demographics
NPI:1124899778
Name:HARRISON, JAVAUGHNI TEMERRA (SUDRC)
Entity type:Individual
Prefix:
First Name:JAVAUGHNI
Middle Name:TEMERRA
Last Name:HARRISON
Suffix:
Gender:F
Credentials:SUDRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1385 MISSION ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2631
Mailing Address - Country:US
Mailing Address - Phone:415-864-7833
Mailing Address - Fax:415-864-2231
Practice Address - Street 1:42 WASHBURN ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2663
Practice Address - Country:US
Practice Address - Phone:415-864-8701
Practice Address - Fax:415-864-0682
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA16894101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)