Provider Demographics
NPI:1215432026
Name:HARRIS, SHAWANA (LCDC)
Entity type:Individual
Prefix:
First Name:SHAWANA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 PACIFIC AVE #7024
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-1209
Mailing Address - Country:US
Mailing Address - Phone:469-677-0831
Mailing Address - Fax:469-677-0832
Practice Address - Street 1:1910 PACIFIC AVE #7024
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201
Practice Address - Country:US
Practice Address - Phone:467-677-0831
Practice Address - Fax:469-677-0832
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12898101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)