Provider Demographics
NPI:1093710485
Name:SEMMLER, CARYLL JEFFERIES (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CARYLL
Middle Name:JEFFERIES
Last Name:SEMMLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:CARYLL
Other - Middle Name:LYNNE
Other - Last Name:JEFFERIES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:5675 OLD FARM LN
Mailing Address - Street 2:
Mailing Address - City:SUDLEY SPRINGS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-2120
Mailing Address - Country:US
Mailing Address - Phone:910-520-0636
Mailing Address - Fax:
Practice Address - Street 1:5675 STONE RD STE 300
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-1667
Practice Address - Country:US
Practice Address - Phone:703-829-5597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004070103T00000X, 103TC0700X
NC2775103TC0700X
NY014694103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCBCBSOtherBLUE CROSS BLUE SHEILD
NC344296OtherMANAGED HEALTH NETWORK
NC2202817OtherCIGNA
NC344296OtherMANAGE HEALTH NETWORK
NC6000583Medicaid