Provider Demographics
NPI:1982432415
Name:HARRIS, THEIA
Entity type:Individual
Prefix:MISS
First Name:THEIA
Middle Name:
Last Name:HARRIS
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:ANEW BEHAVIORAL HEALTH
Mailing Address - Street 2:765 NORTH DETROIT STREET
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385
Mailing Address - Country:US
Mailing Address - Phone:937-608-3257
Mailing Address - Fax:
Practice Address - Street 1:765 N DETROIT ST
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-1960
Practice Address - Country:US
Practice Address - Phone:937-608-3257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty