Provider Demographics
NPI:1679887418
Name:BARRYMORE, JAN L (LPC)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:L
Last Name:BARRYMORE
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 1:223 N BENJAMIN HOWELL ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-7928
Mailing Address - Country:US
Mailing Address - Phone:757-259-1270
Mailing Address - Fax:
Practice Address - Street 1:9228 GEORGE WASHINGTON MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-4162
Practice Address - Country:US
Practice Address - Phone:804-693-5068
Practice Address - Fax:804-695-8122
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004865101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1497717615OtherCARENET/ SOUTHERN HEALTH
VA1497717615Medicaid
VA1497717615OtherVIRGINIA PREMIER
VA294721OtherVALUE OPTIONS