Provider Demographics
NPI:1528737608
Name:HARRISON, VERONICA RENEE
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:RENEE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40318 HIGHWAY 45 S
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MS
Mailing Address - Zip Code:39746-9701
Mailing Address - Country:US
Mailing Address - Phone:662-436-8131
Mailing Address - Fax:
Practice Address - Street 1:40318 HIGHWAY 45 S
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MS
Practice Address - Zip Code:39746-9701
Practice Address - Country:US
Practice Address - Phone:662-436-8131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1333101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health