Healthcare Provider Details

I. General information

NPI: 1295185437
Provider Name (Legal Business Name): KIYAH HARRISON LCSW, LBA, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2016
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 ELDEN ST STE 302
HERNDON VA
20170-4851
US

IV. Provider business mailing address

131 ELDEN ST STE 302
HERNDON VA
20170-4851
US

V. Phone/Fax

Practice location:
  • Phone: 703-496-4371
  • Fax: 703-435-4021
Mailing address:
  • Phone: 631-805-0543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number093453-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133005257
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number002880
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number091844-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: