Provider Demographics
NPI:1528282175
Name:HARRIS, TINA MICHELLE (REGISTERED COUNSELOR)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:MICHELLE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:REGISTERED COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4721 56TH ST E
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98443-2438
Mailing Address - Country:US
Mailing Address - Phone:253-926-0226
Mailing Address - Fax:
Practice Address - Street 1:9500 FRONT ST S STE 100
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-9415
Practice Address - Country:US
Practice Address - Phone:253-584-3996
Practice Address - Fax:253-589-1071
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00050480101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)