Provider Demographics
NPI:1275223745
Name:GROSS, LEE'CHE
Entity Type:Individual
Prefix:
First Name:LEE'CHE
Middle Name:
Last Name:GROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21460 SUBURBAN DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20653-1329
Mailing Address - Country:US
Mailing Address - Phone:804-214-8404
Mailing Address - Fax:
Practice Address - Street 1:21460 SUBURBAN DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON PARK
Practice Address - State:MD
Practice Address - Zip Code:20653-1329
Practice Address - Country:US
Practice Address - Phone:804-214-8404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician