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General NPI Number Information
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NPI Number | 1720720832
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Entity Type | Organization
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Legal Business Name | LEAF BEHAVIOR SUPPORT LLC
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Dates
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Enumeration Date | 04/09/2022
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Last Update Date | 04/09/2022
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Provider Practice Location Address
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Address Line | 3577 BRANNON DR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23456-6913
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Country | US
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Telephone | 757-971-1414
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Fax | 757-937-0287
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Provider Business Mailing Address
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Address Line | 3577 BRANNON DR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23456-6913
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Country | US
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Telephone | 757-971-1414
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Fax | 757-937-0287
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Authorized Official
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Title or Position | CEO
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Name | WHITNEY KING
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Credential | PBS-F
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Telephone | 757-971-1414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 385HR2050X
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Taxonomy Name | Respite Care Camp
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 385HR2055X
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Taxonomy Name | Child Mental Illness Respite Care
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 385HR2065X
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Taxonomy Name | Child Physical Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 372500000X
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Taxonomy Name | Chore Provider
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License Number |
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License Number State |
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