=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831215839
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. VIRGINIA ANNE HARRIS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2007
-----------------------------------------------------
Last Update Date | 02/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5150 SUNRISE BLVD STE B6
-----------------------------------------------------
City | FAIR OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95628-4960
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-961-6090
-----------------------------------------------------
Fax | 916-944-1743
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5150 SUNRISE BLVD STE B6
-----------------------------------------------------
City | FAIR OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95628-4960
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-961-6090
-----------------------------------------------------
Fax | 916-827-0854
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | LMFT27226
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------