Provider Demographics
NPI:1548604705
Name:LEAD CHANGES THERAPY, INC.
Entity Type:Organization
Organization Name:LEAD CHANGES THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:CONCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-643-8715
Mailing Address - Street 1:42395 RYAN RD
Mailing Address - Street 2:SUITE 112-109
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20148-4863
Mailing Address - Country:US
Mailing Address - Phone:571-643-8175
Mailing Address - Fax:
Practice Address - Street 1:42395 RYAN RD
Practice Address - Street 2:SUITE 112-109
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20148-4863
Practice Address - Country:US
Practice Address - Phone:571-643-8175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAB301997251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health