Healthcare Provider Details

I. General information

NPI: 1790791424
Provider Name (Legal Business Name): NANCY MACLEOD LPC, LCPC, NCC, CSAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 WOODBURN RD
ANNANDALE VA
22003-1202
US

IV. Provider business mailing address

1179 FOXHOUND CT
MCLEAN VA
22102-2402
US

V. Phone/Fax

Practice location:
  • Phone: 703-207-7825
  • Fax: 703-280-9518
Mailing address:
  • Phone: 703-790-9484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0710000451
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701002808
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPRC1346
License Number StateDC
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC1145
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: