Healthcare Provider Details

I. General information

NPI: 1023045630
Provider Name (Legal Business Name): MS. BETHANY LORNA MCLEMORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10560 MAIN ST STE 112
FAIRFAX VA
22030-7177
US

IV. Provider business mailing address

321 WINDWARD DR SW
ROANOKE VA
24018-0701
US

V. Phone/Fax

Practice location:
  • Phone: 703-408-9873
  • Fax:
Mailing address:
  • Phone: 540-819-1702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701003259
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number0701003259
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateDC
# 4
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: