Healthcare Provider Details

I. General information

NPI: 1003810615
Provider Name (Legal Business Name): BEVERLY ANN HARRIS CEO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. B A HARRIS

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7703 ROYSTON ST
ANNANDALE VA
22003-5332
US

IV. Provider business mailing address

5510 CHEROKEE AVE
ALEXANDRIA VA
22312-2320
US

V. Phone/Fax

Practice location:
  • Phone: 571-346-2437
  • Fax:
Mailing address:
  • Phone: 571-346-2437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1744R1103X
TaxonomyResearch Study Abstracter/Coder
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: