Provider Demographics
NPI:1093062184
Name:SALLEY-LEROY, TASHA (LPC)
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:
Last Name:SALLEY-LEROY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1328 SOUTHERN AVE SE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-4689
Mailing Address - Country:US
Mailing Address - Phone:301-887-3201
Mailing Address - Fax:
Practice Address - Street 1:9706 WOODVIEW DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-2797
Practice Address - Country:US
Practice Address - Phone:301-887-3201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC14184101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional