Provider Demographics
NPI:1598387987
Name:HARRIS, LANITRA BONNIE JEAN
Entity type:Individual
Prefix:MRS
First Name:LANITRA
Middle Name:BONNIE JEAN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LANITRA
Other - Middle Name:BONNIE JEAN
Other - Last Name:MUHAMMED-HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2127 ARNOLD WAY # 1498
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:CA
Mailing Address - Zip Code:91901-2157
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:451 RIVERVIEW PKWY
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-5829
Practice Address - Country:US
Practice Address - Phone:619-402-1312
Practice Address - Fax:619-258-3208
Is Sole Proprietor?:No
Enumeration Date:2020-05-08
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA141996106H00000X
CA14844101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist