Provider Demographics
NPI:1902452352
Name:HARBIN, LAQUISE SHERMAINE
Entity Type:Individual
Prefix:
First Name:LAQUISE
Middle Name:SHERMAINE
Last Name:HARBIN
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 1:404 15TH ST N
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35203-1845
Mailing Address - Country:US
Mailing Address - Phone:205-777-4022
Mailing Address - Fax:205-777-4023
Practice Address - Street 1:404 15TH ST N
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35203-1845
Practice Address - Country:US
Practice Address - Phone:205-777-4022
Practice Address - Fax:205-777-4023
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3321A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health