Provider Demographics
NPI:1053795799
Name:HARRIS, LORITA (ED D, LPC, NSCS)
Entity type:Individual
Prefix:DR
First Name:LORITA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:ED D, LPC, NSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1268 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-9545
Mailing Address - Country:US
Mailing Address - Phone:662-719-1202
Mailing Address - Fax:
Practice Address - Street 1:1268 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-9545
Practice Address - Country:US
Practice Address - Phone:662-719-1202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1159101YA0400X, 101Y00000X, 101YM0800X, 101YP1600X, 101YP2500X, 101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool