Provider Demographics
NPI:1194052241
Name:HARRIS, CHARLES M JR (S-LPC)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:M
Last Name:HARRIS
Suffix:JR
Gender:M
Credentials:S-LPC
Other - Prefix:MR
Other - First Name:CHAD
Other - Middle Name:M
Other - Last Name:HARRIS
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:205 20TH ST N
Mailing Address - Street 2:SUITE 620
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35203-3609
Mailing Address - Country:US
Mailing Address - Phone:205-370-7901
Mailing Address - Fax:205-801-5169
Practice Address - Street 1:205 20TH ST N
Practice Address - Street 2:SUITE 620
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35203-3609
Practice Address - Country:US
Practice Address - Phone:205-370-7901
Practice Address - Fax:205-801-5169
Is Sole Proprietor?:No
Enumeration Date:2009-11-11
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1796101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional