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MRS. LORRIE A MAYBERRY LPC

Addiction Substance Use Disorder

Woodbridge, Virginia

Provider NPI: 1215979083

Provider Information:
MRS. LORRIE A MAYBERRY LPC
Gender: F
Not Sole Proprietor

Practice Location:
12721 DARBY BROOK CT SUITE 102 WOODBRIDGE, VA 22192 US
Tel: 703-497-1771  Fax: 703-497-1225

Business Mailing Address:
6907 QUANDER RD  ALEXANDRIA, VA 22307 US
Tel: 703-721-3635  Fax: --

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
X101YA0400XBehavioral Health & Social Service Providers
Counselor
Addiction (Substance Use Disorder)
VA0718000123
X101YP2500XBehavioral Health & Social Service Providers
Counselor
VA0701003902

Other Provider Identifiers:

IssuerNumberStateType
MDIPA2140350VA01
SENTARA088656MVI01
ANTHEM188901VI01
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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