Provider Demographics
NPI:1629425517
Name:HARRIS, JAMIEKA (LMSW)
Entity type:Individual
Prefix:
First Name:JAMIEKA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1867 AMHURST CV
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-5133
Mailing Address - Country:US
Mailing Address - Phone:662-404-1429
Mailing Address - Fax:
Practice Address - Street 1:8830 CENTRE ST STE 2
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-2609
Practice Address - Country:US
Practice Address - Phone:662-510-5853
Practice Address - Fax:662-528-4745
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-20
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC-8374104100000X
TN73811041C0700X
MSM8374101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical