Provider Demographics
NPI:1518472448
Name:HARRIS, ELIZABETH (MA, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 MANNING LN
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-5021
Mailing Address - Country:US
Mailing Address - Phone:757-719-3472
Mailing Address - Fax:
Practice Address - Street 1:12610 PATRICK HENRY DR STE M
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-9538
Practice Address - Country:US
Practice Address - Phone:757-817-0089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-14
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
VA0133001911103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty