Provider Demographics
NPI:1396854022
Name:DICHARRY, KAY M (PHD, LCP)
Entity Type:Individual
Prefix:DR
First Name:KAY
Middle Name:M
Last Name:DICHARRY
Suffix:
Gender:F
Credentials:PHD, LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 HERITAGE WAY NE STE 302
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-4544
Mailing Address - Country:US
Mailing Address - Phone:703-771-5100
Mailing Address - Fax:703-777-0170
Practice Address - Street 1:102 HERITAGE WAY NE
Practice Address - Street 2:SUITE 302
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4544
Practice Address - Country:US
Practice Address - Phone:703-771-5100
Practice Address - Fax:703-777-0170
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002492101YP2500X
VA0810000290103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA287547OtherANTHEM, LEESBURG
VA287548OtherANTHEM, ELMHC
VA293874OtherAMERIGROUP