Provider Demographics
NPI:1548857725
Name:WILLIAMS, LEISA A (NCSP)
Entity type:Individual
Prefix:DR
First Name:LEISA
Middle Name:A
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 NIDAY DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-4633
Mailing Address - Country:US
Mailing Address - Phone:571-216-7224
Mailing Address - Fax:
Practice Address - Street 1:6 NIDAY DR
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556-4633
Practice Address - Country:US
Practice Address - Phone:571-216-7224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool