Doctor Name: | DWAYNE K HARRIS |
NPI Number: | 1003114760 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | CAC III |
License Number: | 6900 |
Business Practice Address: | 1155 Cherokee St Denver, CO - 802043632 |
Business Phone Number: | 3034366000 |
Business Fax Number: | |
Mailing Address: | 777 Bannock St, Mc 7782 DENVER |
State: | CO |
Postal Code: | 802044507 |
Phone Number: | 3034366000 |
Fax Number: | |
NPI Enumeration Date: | 03/04/2011 |
NPI Last Update Date: | 03/04/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 6900 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |