Provider Demographics
NPI:1548328131
Name:MEYERS, LAURIE ANN (LCSW)
Entity type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:ANN
Last Name:MEYERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11250 ROGER BACON DR STE 17
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5202
Mailing Address - Country:US
Mailing Address - Phone:703-464-5800
Mailing Address - Fax:703-464-5800
Practice Address - Street 1:11250 ROGER BACON DR STE 17
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5202
Practice Address - Country:US
Practice Address - Phone:703-464-5800
Practice Address - Fax:703-464-5800
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040030891041C0700X
CALCS155681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical