Provider Demographics
NPI:1972922631
Name:PARKER-LEWIS, BEVERLY ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:ANN
Last Name:PARKER-LEWIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 HERNDON MILL CIR
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4478
Mailing Address - Country:US
Mailing Address - Phone:703-405-7278
Mailing Address - Fax:
Practice Address - Street 1:712 PINE ST
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4603
Practice Address - Country:US
Practice Address - Phone:703-405-7278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003935103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical