Provider Demographics
NPI:1649740572
Name:LEAP THERAPEUTIC SERVICES
Entity Type:Organization
Organization Name:LEAP THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLSOPP
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-977-2100
Mailing Address - Street 1:700 TECH CENTER PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-3075
Mailing Address - Country:US
Mailing Address - Phone:757-977-2100
Mailing Address - Fax:757-210-3969
Practice Address - Street 1:700 TECH CENTER PKWY STE 200
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3075
Practice Address - Country:US
Practice Address - Phone:757-772-1009
Practice Address - Fax:757-210-3969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-04
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty