Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 0810003911 | VA |
Y | 103TC0700X | Clinical Psychologist | 0810003911 | VA |
NPI | 1003235003 |
---|---|
Provider Name | Mrs. Valerie Leake |
First Address | Christiansburg, VA 24073-3025 |
Second Address | Christiansburg, VA 24073-3025 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2014 |
Last Update Date | 08/04/2014 |