Provider Demographics
NPI:1396854972
Name:MCKEOUGH, LESLIE ANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:ANN
Last Name:MCKEOUGH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42639 FRONTIER DR
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20148-7209
Mailing Address - Country:US
Mailing Address - Phone:703-542-6962
Mailing Address - Fax:
Practice Address - Street 1:105 LOUDOUN ST SE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-3106
Practice Address - Country:US
Practice Address - Phone:703-909-9877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040063751041C0700X
MA1135941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical