Provider Demographics
NPI:1588300354
Name:HARRIS, NICOLE ANTIONETTE (LPC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANTIONETTE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:WILKINSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15221-2118
Mailing Address - Country:US
Mailing Address - Phone:412-735-8007
Mailing Address - Fax:
Practice Address - Street 1:221 PENN AVE
Practice Address - Street 2:
Practice Address - City:WILKINSBURG
Practice Address - State:PA
Practice Address - Zip Code:15221-2118
Practice Address - Country:US
Practice Address - Phone:412-735-8007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC014435101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional