Healthcare Provider Details

I. General information

NPI: 1265344568
Provider Name (Legal Business Name): LEAH SOPHIE KEITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 JAMESTOWN RD STE 203
WILLIAMSBURG VA
23185-3303
US

IV. Provider business mailing address

1315 JAMESTOWN RD STE 203
WILLIAMSBURG VA
23185-3303
US

V. Phone/Fax

Practice location:
  • Phone: 757-603-4603
  • Fax: 757-257-9146
Mailing address:
  • Phone: 757-603-4603
  • Fax: 757-257-9146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: