Healthcare Provider Details

I. General information

NPI: 1720671399
Provider Name (Legal Business Name): HARRISON ALEXANDER WEST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2021
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7229 G ST
CAPITOL HEIGHTS MD
20743-1870
US

IV. Provider business mailing address

7229 G ST
CAPITOL HEIGHTS MD
20743-1870
US

V. Phone/Fax

Practice location:
  • Phone: 301-778-4737
  • Fax:
Mailing address:
  • Phone: 301-778-4737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904017796
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLG50082342
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number25551
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: