Provider Demographics
NPI:1972612018
Name:BAIN, LORI LEIGH (LPC , LMFT)
Entity type:Individual
Prefix:MR
First Name:LORI
Middle Name:LEIGH
Last Name:BAIN
Suffix:
Gender:F
Credentials:LPC , LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 HAMPTON FOREST WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-7205
Mailing Address - Country:US
Mailing Address - Phone:703-266-2843
Mailing Address - Fax:703-263-1724
Practice Address - Street 1:5500 HAMPTON FOREST WAY
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7205
Practice Address - Country:US
Practice Address - Phone:703-266-2843
Practice Address - Fax:703-263-1724
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2398101YP2500X
VA000826106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist