Provider Demographics
NPI:1366909905
Name:HARRIS, DONALD (PC)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1072
Mailing Address - Street 2:
Mailing Address - City:MERCHANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-0572
Mailing Address - Country:US
Mailing Address - Phone:732-570-1526
Mailing Address - Fax:
Practice Address - Street 1:401 BURROUGHS MILL CT
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-1260
Practice Address - Country:US
Practice Address - Phone:732-570-1526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-01
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00454100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health