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Individual

CHARLES MACLOREN HARRIS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LCSW

Contact information

Practice address
830 CHALKSTONE AVE, PROVIDENCE VA MEDICAL CENTER, PROVIDENCE, RI 02908-4734
(401) 459-4700
Mailing address
103 COUNTRY CLUB LN, HOPKINSVILLE, KY 42240-3865
(775) 843-5807

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
254440
KY
1041C0700X
Clinical Social Worker
6801091712
MI

Other

Enumeration date
03/22/2011
Last updated
10/17/2019
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