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General NPI Number Information
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NPI Number | 1376363671
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Entity Type | Individual
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Provider Name | JADE MICHAELA LEAP M.ED., LPC
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Gender | Female
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Dates
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Enumeration Date | 10/12/2024
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Last Update Date | 10/12/2024
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Provider Practice Location Address
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Address Line | 21351 GENTRY DR STE 200
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City | STERLING
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State | VA
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Zip | 20166-8512
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Country | US
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Telephone | 703-493-0891
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Fax |
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Provider Business Mailing Address
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Address Line | 4022 POMEL DR
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City | COLLEGE STATION
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State | TX
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Zip | 77845-5099
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Country | US
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Telephone | 540-908-6846
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701014029
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 93799
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License Number State | TX
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