Healthcare Provider Details

I. General information

NPI: 1033045455
Provider Name (Legal Business Name): ALYSSIA VANNARATH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9720 CAPITAL CT STE 108
MANASSAS VA
20110-2049
US

IV. Provider business mailing address

9720 CAPITAL CT STE 108
MANASSAS VA
20110-2049
US

V. Phone/Fax

Practice location:
  • Phone: 703-770-8060
  • Fax: 703-748-2212
Mailing address:
  • Phone: 703-770-8060
  • Fax: 703-748-2212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: