Provider Demographics
NPI:1295216422
Name:BRISCOE, LEEAD SARA DIDIO (LGPC)
Entity Type:Individual
Prefix:
First Name:LEEAD
Middle Name:SARA DIDIO
Last Name:BRISCOE
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3460 14TH ST NW APT 122
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-3496
Mailing Address - Country:US
Mailing Address - Phone:702-493-7113
Mailing Address - Fax:
Practice Address - Street 1:3460 14TH ST NW APT 122
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-3496
Practice Address - Country:US
Practice Address - Phone:702-493-7113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-26
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLGPC00388101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health