Provider Demographics
NPI:1508677915
Name:NEYER, COREY MARTIN (L-RIC)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:MARTIN
Last Name:NEYER
Suffix:
Gender:M
Credentials:L-RIC
Other - Prefix:
Other - First Name:COREY
Other - Middle Name:MARTIN
Other - Last Name:MEMMOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:L-RIC
Mailing Address - Street 1:44131 TIPPECANOE TER
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-4821
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:906 TRAILVIEW BLVD SE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-4415
Practice Address - Country:US
Practice Address - Phone:703-777-0377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704016412101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health