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General NPI Number Information
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NPI Number | 1992029920
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Entity Type | Individual
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Provider Name | DEVERY CHARLES LANDRUM LCSW
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Gender | Male
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Dates
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Enumeration Date | 03/19/2010
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Last Update Date | 08/19/2022
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Provider Practice Location Address
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Address Line | 44121 HARRY BYRD HWY STE 275
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City | ASHBURN
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State | VA
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Zip | 20147-5671
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Country | US
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Telephone | 571-325-6675
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Fax | 703-421-4285
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Provider Business Mailing Address
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Address Line | PO BOX 650771
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City | STERLING
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State | VA
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Zip | 20165-0771
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Country | US
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Telephone | 571-325-6675
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Fax | 703-421-4285
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904007330
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License Number State | VA
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