Healthcare Provider Details

I. General information

NPI: 1649187576
Provider Name (Legal Business Name): LERAH GORDON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24560 SOUTHPOINT DR STE 260
ALDIE VA
20105-3505
US

IV. Provider business mailing address

24560 SOUTHPOINT DR STE 260
ALDIE VA
20105-3505
US

V. Phone/Fax

Practice location:
  • Phone: 571-248-7472
  • Fax:
Mailing address:
  • Phone: 571-248-7472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0903004654
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: