Provider Demographics
NPI:1013888783
Name:HARRIS, ABI ROSE
Entity type:Individual
Prefix:
First Name:ABI
Middle Name:ROSE
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 1:4908 RANDEE CIR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32526-2054
Mailing Address - Country:US
Mailing Address - Phone:985-413-8127
Mailing Address - Fax:850-466-0024
Practice Address - Street 1:4908 RANDEE CIR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32526-2054
Practice Address - Country:US
Practice Address - Phone:985-413-8127
Practice Address - Fax:850-466-0024
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-25-454254106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty