MEDICARE: MS. CONSTANCE THAYER CORY LMFT

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	101YM0800X	Mental Health Counselor	0701001193	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	082139	OTHER	VA	OPTIMA
2	140811	OTHER	VA	ANTHEM
3	2123565	OTHER	VA	MAMSI
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	033353	OTHER	VA	VALUE OPTIONS
6	2037029	OTHER	VA	CIGNA

General Provider Information

NPI Number	:	1811093925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CONSTANCE THAYER CORY LMFT

Provider Business Mailing Address
First Line	:	1318 JAMESTOWN RD
Second Line	:	SUITE 101
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23185-3382
Country	:	US
Telephone Number	:	757-229-7927
Fax Number	:	757-253-8891

Provider Business Practice Location Address
First Line	:	1318 JAMESTOWN RD
Second Line	:	SUITE 101
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23185-3382
Country	:	US
Telephone Number	:	757-229-7927
Fax Number	:	757-253-8891

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

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	07/09/2007

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Directions to “ MS. CONSTANCE THAYER CORY LMFT” Practice Location

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