Provider Demographics
NPI:1134095664
Name:HARRIS, KIA KATHERINE
Entity type:Individual
Prefix:
First Name:KIA
Middle Name:KATHERINE
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 1:1705 WASHINGTON ST STE F
Mailing Address - Street 2:
Mailing Address - City:CALISTOGA
Mailing Address - State:CA
Mailing Address - Zip Code:94515-1573
Mailing Address - Country:US
Mailing Address - Phone:310-734-0593
Mailing Address - Fax:
Practice Address - Street 1:608 SARATOGA DR
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:VA
Practice Address - Zip Code:23801-1106
Practice Address - Country:US
Practice Address - Phone:804-429-4321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT155891APCC1982101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health