Active NPI
Charles Mickel Harris
- Addiction (Substance Use Disorder) Counselor
- Rock Island, IL
National Provider Identifier
1780190165
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- Practice address
- 2701 17TH St
Rock Island, IL 61201-5351 - Phone
- (309) 779-2285
- NPI assigned
- Dec 20, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | Primary |
Addresses
Primary practice location
2701 17TH St
Rock Island, IL 61201-5351
Mailing address
3470 N Willow CT Apt 3
Bettendorf, IA 52722-2872
Phone (563) 357-6299
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1513728000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1513728000000",
"number": "1780190165",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3470 N WILLOW CT APT 3",
"city": "BETTENDORF",
"state": "IA",
"postal_code": "527222872",
"telephone_number": "563-357-6299"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2701 17TH ST",
"city": "ROCK ISLAND",
"state": "IL",
"postal_code": "612015351",
"telephone_number": "309-779-2285"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARRIS",
"first_name": "CHARLES",
"middle_name": "MICKEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-12-20",
"last_updated": "2017-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rock Island, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.