MEDICARE: MS. BEVERLY ANN HARRIS CEO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	171400000X	Health & Wellness Coach	VA
2	1744R1103X	Research Study Abstracter/Coder
3	106S00000X	Behavior Technician	VA
4	374U00000X	Home Health Aide	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	032173	OTHER	DC	NONE

General Provider Information

NPI Number	:	1003810615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BEVERLY ANN HARRIS CEO

Provider Business Mailing Address
First Line	:	5510 CHEROKEE AVE
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22312-2320
Country	:	US
Telephone Number	:	571-346-2437
Fax Number	:

Provider Business Practice Location Address
First Line	:	7703 ROYSTON ST
Second Line	:
City	:	ANNANDALE
State	:	VA
Zip	:	22003-5332
Country	:	US
Telephone Number	:	571-346-2437
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	10/01/2025

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