Provider Demographics
NPI:1164678330
Name:WEAVER, MARIA (LPC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 J CLYDE MORRIS BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1540
Mailing Address - Country:US
Mailing Address - Phone:757-690-0741
Mailing Address - Fax:757-595-1885
Practice Address - Street 1:718 J CLYDE MORRIS BLVD STE D
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-1540
Practice Address - Country:US
Practice Address - Phone:757-690-0741
Practice Address - Fax:757-595-1885
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008268101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional