Healthcare Provider Details

I. General information

NPI: 1821414970
Provider Name (Legal Business Name): TIFFANY LEATHERBERRY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2014
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12300 WASHINGTON HWY
ASHLAND VA
23005-7646
US

IV. Provider business mailing address

12300 WASHINGTON HWY
ASHLAND VA
23005-7646
US

V. Phone/Fax

Practice location:
  • Phone: 804-365-4222
  • Fax: 804-365-4252
Mailing address:
  • Phone: 301-523-7210
  • Fax: 804-365-4252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC14417
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: