Provider Demographics
NPI:1093436503
Name:NEW LEAF THERAPY LLC
Entity Type:Organization
Organization Name:NEW LEAF THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:OWEN
Authorized Official - Last Name:CONLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-841-6938
Mailing Address - Street 1:1892 GRAVES MILL RD UNIT A
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-5097
Mailing Address - Country:US
Mailing Address - Phone:434-841-6938
Mailing Address - Fax:
Practice Address - Street 1:1892 GRAVES MILL RD UNIT A
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-5097
Practice Address - Country:US
Practice Address - Phone:434-841-6938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-05
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty