Provider Demographics
NPI:1609353036
Name:HARRIS, ROSIE THORNTON (ALC)
Entity type:Individual
Prefix:MS
First Name:ROSIE
Middle Name:THORNTON
Last Name:HARRIS
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1506
Mailing Address - Country:US
Mailing Address - Phone:334-649-2966
Mailing Address - Fax:
Practice Address - Street 1:1720 W 3RD ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1506
Practice Address - Country:US
Practice Address - Phone:334-649-2966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC2983A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health