Individual provider Active NPI

Randall Wayne Drury, LCSW

  • Clinical Social Worker
  • Fairfax, VA
National Provider Identifier
1720816390
Registry record updated Jun 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
0904017141 Issued in VA
Practice address
11166 Fairfax Blvd Ste 500
Fairfax, VA 22030-5017
Phone
(571) 412-1002
NPI assigned
Jul 24, 2024
Last updated
Jun 25, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 0904017141 VA
Clinical Social Worker 1041C0700X 0904017141 VA Primary

Addresses

Primary practice location

11166 Fairfax Blvd Ste 500
Fairfax, VA 22030-5017

Mailing address

8221 Willow Oaks Corporate Dr
Fairfax, VA 22031-4512
Phone (703) 207-7828

Other practice location 1

8221 Willow Oaks Corporate Dr
Fairfax, VA 22031-4512
Phone (571) 412-1002

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240820001745 DC Practitioner - Clinical Social Worker 3375081409 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

8221 Willow Oaks Corporate Dr
Fairfax Falls Church Community Services Boa
Fairfax, VA 22031-4512
Phone (703) 321-7000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0904017141VAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Fairfax County, Virginia Mental Health (Including Community Mental Health Center) CurrentSince Jul 23, 2024 Accepting new patients
Transform by Renewing Counseling LLC Clinical Current Accepting new patients

Locations

11166 Fairfax Blvd
Ste 500
Fairfax, VA 22030
Phone (703) 403-2750

12011 Government Center Pkwy
Ste 836
Fairfax, VA 22035
Phone (703) 324-7017

8221 Willow Oaks Corporate Dr
Fairfax, VA 22031
Phone (703) 289-7599

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1721779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782345600000",
    "number": "1720816390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8221 WILLOW OAKS CORPORATE DR",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220314512",
            "telephone_number": "703-207-7828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11166 FAIRFAX BLVD STE 500",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220305017",
            "telephone_number": "571-412-1002"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8221 Willow Oaks Corporate Dr",
            "address_purpose": "LOCATION",
            "city": "Fairfax",
            "state": "VA",
            "postal_code": "220314512",
            "country_code": "US",
            "telephone_number": "571-412-1002",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DRURY",
        "first_name": "RANDALL",
        "middle_name": "WAYNE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-07-24",
        "last_updated": "2026-06-25",
        "certification_date": "2026-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "VA",
            "license": "0904017141",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904017141",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfax, VA

Sources for this page

Verify at the official NPI Registry.