Healthcare Provider Details

I. General information

NPI: 1922939099
Provider Name (Legal Business Name): LEAH G DOUGLAS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 CAMPBELL AVE SW
ROANOKE VA
24016-3625
US

IV. Provider business mailing address

5201 ARCHER DR
ROANOKE VA
24018-8601
US

V. Phone/Fax

Practice location:
  • Phone: 540-795-4661
  • Fax: 540-563-5254
Mailing address:
  • Phone: 540-795-4661
  • Fax: 540-563-5254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0904020524
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: