MEDICARE: MRS. LORRIE A MAYBERRY LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	0718000123	VA
2	101YP2500X	Professional Counselor	0701003902	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	188901	OTHER	VI	ANTHEM
2	088656M	OTHER	VI	SENTARA
3	2140350	OTHER	VA	MDIPA

General Provider Information

NPI Number	:	1215979083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LORRIE A MAYBERRY LPC

Provider Business Mailing Address
First Line	:	6907 QUANDER RD
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22307-1657
Country	:	US
Telephone Number	:	703-721-3635
Fax Number	:

Provider Business Practice Location Address
First Line	:	12721 DARBY BROOK CT
Second Line	:	SUITE 102
City	:	WOODBRIDGE
State	:	VA
Zip	:	22192-2408
Country	:	US
Telephone Number	:	703-497-1771
Fax Number	:	703-497-1225

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	09/11/2025

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