Provider Demographics
NPI:1093925141
Name:MCCORMACK, ANDREA BETH (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:BETH
Last Name:MCCORMACK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:BETH
Other - Last Name:SCHWENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:14808 MILLICENT CT
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-1867
Mailing Address - Country:US
Mailing Address - Phone:816-405-7499
Mailing Address - Fax:571-655-2201
Practice Address - Street 1:5675 STONE RD STE 310
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:816-405-7499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007134101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3001745073001Medicaid