Healthcare Provider Details

I. General information

NPI: 1801302930
Provider Name (Legal Business Name): LEAH DARE SANDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2017
Last Update Date: 12/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4509 WHITECHAPEL DR
VIRGINIA BEACH VA
23455-6447
US

IV. Provider business mailing address

3640 BRITT TER
VIRGINIA BEACH VA
23452-3614
US

V. Phone/Fax

Practice location:
  • Phone: 757-460-4655
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701007430
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: