Healthcare Provider Details

I. General information

NPI: 1659195741
Provider Name (Legal Business Name): HALLIE HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 MOUNT CROSS RD
DANVILLE VA
24540-5904
US

IV. Provider business mailing address

708 MOUNT CROSS RD
DANVILLE VA
24540-5904
US

V. Phone/Fax

Practice location:
  • Phone: 434-228-7603
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133005242
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: