Provider Demographics
NPI:1053920801
Name:HARRIS, SARINA RENEE
Entity type:Individual
Prefix:
First Name:SARINA
Middle Name:RENEE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2387 S LINDEN RD STE 137
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-5488
Mailing Address - Country:US
Mailing Address - Phone:989-475-4171
Mailing Address - Fax:989-393-6021
Practice Address - Street 1:2387 S LINDEN RD STE 137
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5488
Practice Address - Country:US
Practice Address - Phone:989-475-4171
Practice Address - Fax:989-393-6021
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010964931041C0700X
MI6801108584104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical