Basic Information
Provider Information
NPI: 1619063070
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HARRIS-MCGHEE
FirstName: SONYA
MiddleName: RHYNETTE
NamePrefix: MRS.
NameSuffix:  
Credential: MED
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: HARRIS
OtherFirstName: SONYA
OtherMiddleName: RHYNETTE
OtherNamePrefix: MS.
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 3810 WINCHESTER
Address2: SOUTHEAST MHC
City: MEMPHIS
State: TN
PostalCode: 381189007
CountryCode: US
TelephoneNumber: 9013691400
FaxNumber: 9013691433
Practice Location
Address1: 3810 WINCHESTER RD
Address2: SOUTHEAST MENTAL HEALTH HEALTH CTR
City: MEMPHIS
State: TN
PostalCode: 381189007
CountryCode: US
TelephoneNumber: 9013691420
FaxNumber: 9013691433
Other Information
ProviderEnumerationDate: 10/05/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101Y00000X  X Behavioral Health & Social Service ProvidersCounselor 
101YM0800X  X Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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