Provider Demographics
NPI:1619442241
Name:HARRIS, DAYTONA C (LSW)
Entity type:Individual
Prefix:
First Name:DAYTONA
Middle Name:C
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20131 NICHOLAS AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-3007
Mailing Address - Country:US
Mailing Address - Phone:216-630-1754
Mailing Address - Fax:
Practice Address - Street 1:20131 NICHOLAS AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-3007
Practice Address - Country:US
Practice Address - Phone:216-630-1754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-10
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1700619104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker