Marita M Harris, PCAC
Individual provider Active NPI Counselor · Petal, MS
NPI 1508098245 · NPPES record last updated Aug 13, 2009
Key facts
- NPI
- 1508098245
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- License
- PA0043 (MS)
- Practice address
- 29 Clinton
Petal, MS 39465-8708 - Phone
- (601) 705-1901
- NPI assigned
- Aug 13, 2009
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA0043 | MS | MD | Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | PA0043 | MS | Yes |
Addresses
Primary practice location
29 Clinton
Petal, MS 39465-8708
Mailing address
29 Clinton
Petal, MS 39465-8708
Phone (601) 705-1901
Other providers in Petal, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 13, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.