Organization Name: | LEESBURG COMMUNITY CHURCH |
NPI Number: | 1013206200 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TIMOTHY J TEAGUE (DIRECTOR) |
Mailing Address: | 815 Lee Ave Sw Ste B Leesburg |
State: | VA US |
Postal Code: | 201753416 |
Phone Number: | 7037772209 |
Fax Number: | |
NPI Enumeration Date: | 03/29/2011 |
NPI Last Update Date: | 03/29/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 0701001459 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |