Provider Demographics
NPI:1457234791
Name:BERRY, ALIJAH
Entity type:Individual
Prefix:
First Name:ALIJAH
Middle Name:
Last Name:BERRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:844 FALLS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-7297
Mailing Address - Country:US
Mailing Address - Phone:516-778-0195
Mailing Address - Fax:
Practice Address - Street 1:2909 SAVILLE GARDEN WAY
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23453-7032
Practice Address - Country:US
Practice Address - Phone:757-450-8507
Practice Address - Fax:757-585-3544
Is Sole Proprietor?:No
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VABACB1354625106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician