Individual
MRS. ANDREA BETH MCCORMACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
5675 STONE RD STE 310, CENTREVILLE, VA 20120-1667
(816) 405-7499
Mailing address
6165 GOTHWAITE DRIVE, CENTREVILLE, VA 20120-1817
(816) 405-7499
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0701007134
VA
101YP2500X
Professional Counselor
0701007134
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3001745073001
—
VA
Enumeration date
05/23/2007
Last updated
08/06/2025
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