Provider Demographics
NPI:1831852599
Name:HARRIS, SHAQUANDRIA QUINTINETTE (LPC-A)
Entity type:Individual
Prefix:
First Name:SHAQUANDRIA
Middle Name:QUINTINETTE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 181
Mailing Address - Street 2:
Mailing Address - City:RICHBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29729-0181
Mailing Address - Country:US
Mailing Address - Phone:803-374-4090
Mailing Address - Fax:
Practice Address - Street 1:200 SPRINGTREE DR STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-8614
Practice Address - Country:US
Practice Address - Phone:803-722-4975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-20
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7595101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1568476885Medicaid