Provider Demographics
NPI:1528738606
Name:HARRIS, DONALDA TAMMYR
Entity type:Individual
Prefix:MS
First Name:DONALDA
Middle Name:TAMMYR
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 1:5822 ENZOR ST APT B
Mailing Address - Street 2:
Mailing Address - City:CALLAWAY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-8290
Mailing Address - Country:US
Mailing Address - Phone:850-481-9722
Mailing Address - Fax:
Practice Address - Street 1:2404 RUTH HENTZ AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-2258
Practice Address - Country:US
Practice Address - Phone:850-257-5998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-184638106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician