Provider Demographics
NPI:1598130262
Name:WEYRICK, DAPHNE KRISTIN (LPC)
Entity Type:Individual
Prefix:
First Name:DAPHNE
Middle Name:KRISTIN
Last Name:WEYRICK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:DAPHNE
Other - Middle Name:KRISTIN
Other - Last Name:GODFREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4393 KEVIN WALKER DR # 1016
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22025-1636
Mailing Address - Country:US
Mailing Address - Phone:571-572-2451
Mailing Address - Fax:
Practice Address - Street 1:4393 KEVIN WALKER DR # 1016
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22025-1636
Practice Address - Country:US
Practice Address - Phone:571-572-2451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-07
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
VA0701006340101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional