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General NPI Number Information
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NPI Number | 1508677915
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Entity Type | Individual
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Provider Name | COREY MARTIN NEYER L-RIC
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Gender | Male
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Dates
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Enumeration Date | 01/15/2025
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 906 TRAILVIEW BLVD SE
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City | LEESBURG
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State | VA
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Zip | 20175-4415
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Country | US
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Telephone | 703-777-0377
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Fax |
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Provider Business Mailing Address
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Address Line | 44131 TIPPECANOE TER
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City | ASHBURN
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State | VA
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Zip | 20147-4821
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0704016412
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License Number State | VA
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