Provider Demographics
NPI:1790284537
Name:HARRIS, ALICIA RASHELLE
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:RASHELLE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 W COMMERCE RD APT 322
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-2374
Mailing Address - Country:US
Mailing Address - Phone:804-528-2158
Mailing Address - Fax:
Practice Address - Street 1:151 W COMMERCE RD APT 322
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-2374
Practice Address - Country:US
Practice Address - Phone:804-528-2158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0185019616171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0185019616Medicaid