Provider Demographics
NPI:1215979083
Name:MAYBERRY, LORRIE A (LPC)
Entity type:Individual
Prefix:MRS
First Name:LORRIE
Middle Name:A
Last Name:MAYBERRY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6907 QUANDER RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22307-1657
Mailing Address - Country:US
Mailing Address - Phone:703-721-3635
Mailing Address - Fax:
Practice Address - Street 1:12721 DARBY BROOK CT
Practice Address - Street 2:SUITE 102
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2408
Practice Address - Country:US
Practice Address - Phone:703-497-1771
Practice Address - Fax:703-497-1225
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0718000123101YA0400X
VA0701003902101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI188901OtherANTHEM
VI088656MOtherSENTARA
VA2140350OtherMDIPA