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General NPI Number Information
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NPI Number | 1265216147
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Entity Type | Individual
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Provider Name | LEAH ARIANA GRANDE PHD
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Gender | Female
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Dates
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Enumeration Date | 08/22/2023
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Last Update Date | 01/30/2026
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Provider Practice Location Address
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Address Line | 5244 LYNGATE CT STE 200
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City | BURKE
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State | VA
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Zip | 22015-1631
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Country | US
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Telephone | 703-910-2577
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Fax | 703-661-9463
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Provider Business Mailing Address
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Address Line | 5244 LYNGATE CT STE 200
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City | BURKE
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State | VA
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Zip | 22015-1631
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Country | US
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Telephone | 703-910-2577
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Fax | 703-661-9463
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PSYC.00015146
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 027356
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 35SI00781700
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSYC.00015146
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License Number State | CO
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