Provider Demographics
NPI:1245708460
Name:HARRIS, STACEY REID (LPC)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:REID
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 JORDANS JOURNEY
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-1444
Mailing Address - Country:US
Mailing Address - Phone:757-262-8828
Mailing Address - Fax:
Practice Address - Street 1:5000 NEW POINT RD STE 3201
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-9423
Practice Address - Country:US
Practice Address - Phone:757-645-3558
Practice Address - Fax:757-645-3668
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003146101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional