Provider Demographics
NPI:1457648792
Name:LEONARD, CHERYL NICOLE
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:NICOLE
Last Name:LEONARD
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 1:101 LISBON CT
Mailing Address - Street 2:APT 101
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3183
Mailing Address - Country:US
Mailing Address - Phone:757-615-3003
Mailing Address - Fax:757-474-0987
Practice Address - Street 1:101 LISBON CT
Practice Address - Street 2:APT 101
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3183
Practice Address - Country:US
Practice Address - Phone:757-615-3003
Practice Address - Fax:757-474-0987
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1-11-8644103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst