Provider Demographics
NPI:1972961357
Name:HARRIS, BRENT C (MA, LPC)
Entity type:Individual
Prefix:MR
First Name:BRENT
Middle Name:C
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 SUMIT WOOD DR NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-4155
Mailing Address - Country:US
Mailing Address - Phone:678-951-6778
Mailing Address - Fax:
Practice Address - Street 1:4010 SUMIT WOOD DR NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-4155
Practice Address - Country:US
Practice Address - Phone:678-951-6778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008775101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional