MEDICARE: MS. NANCY ELLMANN LEONARD M.A., LPC, CSAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	0710102805	VA
2	101YP2500X	Professional Counselor	0701007835	VA

General Provider Information

NPI Number	:	1932515046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NANCY ELLMANN LEONARD M.A., LPC, CSAC

Provider Business Mailing Address
First Line	:	10049 MIDLOTHIAN TPKE STE B2
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-4859
Country	:	US
Telephone Number	:	804-647-3382
Fax Number	:	804-323-0602

Provider Business Practice Location Address
First Line	:	10049 MIDLOTHIAN TPKE STE B2
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-4859
Country	:	US
Telephone Number	:	804-647-3382
Fax Number	:	804-323-0602

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2014
Last Update Date	:	08/09/2019

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