Provider Demographics
NPI:1346053345
Name:HARRIS, VANESSA NICHELLE (MHCAMC61445441)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:NICHELLE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MHCAMC61445441
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7219 224TH ST SW APT K7
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8344
Mailing Address - Country:US
Mailing Address - Phone:253-226-8737
Mailing Address - Fax:
Practice Address - Street 1:7219 224TH ST SW APT K7
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8344
Practice Address - Country:US
Practice Address - Phone:253-226-8737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMHCA.MC.61445441101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty