Provider Demographics
NPI:1528240280
Name:HARRIS, DAMITA JO (PROF COUNSELOR LTD)
Entity type:Individual
Prefix:MS
First Name:DAMITA
Middle Name:JO
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PROF COUNSELOR LTD
Other - Prefix:MS
Other - First Name:DAMITA
Other - Middle Name:JO
Other - Last Name:HARRIS-KNOWLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PROF COUNSELOR LTD
Mailing Address - Street 1:12919 DIXIE
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-2601
Mailing Address - Country:US
Mailing Address - Phone:313-623-6244
Mailing Address - Fax:313-277-3414
Practice Address - Street 1:1800 GRINDLEY PARK ST
Practice Address - Street 2:SUITE 1
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2553
Practice Address - Country:US
Practice Address - Phone:313-623-6244
Practice Address - Fax:313-277-3414
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007360101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional