Provider Demographics
NPI:1124686050
Name:DEBERRY, LERESE A (LPC)
Entity type:Individual
Prefix:
First Name:LERESE
Middle Name:A
Last Name:DEBERRY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:LERESE
Other - Middle Name:ADREINNE
Other - Last Name:DEBERRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, 06/13/2018
Mailing Address - Street 1:10900 NUCKOLS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9277
Mailing Address - Country:US
Mailing Address - Phone:804-207-6737
Mailing Address - Fax:
Practice Address - Street 1:10900 NUCKOLS RD STE 100
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-9277
Practice Address - Country:US
Practice Address - Phone:804-207-6737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-05
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007692101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional