Provider Demographics
NPI:1609115617
Name:HARRIS, MEGAN (MS)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3651 MARS HILL RD STE 500B
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-5988
Mailing Address - Country:US
Mailing Address - Phone:870-219-1071
Mailing Address - Fax:
Practice Address - Street 1:3651 MARS HILL RD STE 500B
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-5988
Practice Address - Country:US
Practice Address - Phone:870-219-1071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-11
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008692101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional