Provider Demographics
NPI:1043634975
Name:HARRIS, DARRIN
Entity type:Individual
Prefix:
First Name:DARRIN
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2214 25TH AVE
Mailing Address - Street 2:UNIT 1
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-4520
Mailing Address - Country:US
Mailing Address - Phone:504-858-4673
Mailing Address - Fax:
Practice Address - Street 1:2214 25TH AVE
Practice Address - Street 2:UNIT 1
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-4520
Practice Address - Country:US
Practice Address - Phone:504-858-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral