Provider Demographics
NPI:1609673383
Name:HARRIS, LAWRENCE DEANDRE
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:DEANDRE
Last Name:HARRIS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3224 MCHENRY AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-1400
Mailing Address - Country:US
Mailing Address - Phone:209-900-4546
Mailing Address - Fax:
Practice Address - Street 1:3224 MCHENRY AVE STE C
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-1400
Practice Address - Country:US
Practice Address - Phone:209-900-4546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician