Provider Demographics
NPI:1659992584
Name:LEAF BEHAVIOR SUPPORT LLC
Entity Type:Organization
Organization Name:LEAF BEHAVIOR SUPPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-971-1414
Mailing Address - Street 1:3577 BRANNON DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-6913
Mailing Address - Country:US
Mailing Address - Phone:757-971-1414
Mailing Address - Fax:757-937-0287
Practice Address - Street 1:3577 BRANNON DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-6913
Practice Address - Country:US
Practice Address - Phone:757-971-1414
Practice Address - Fax:757-937-0287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-01
Last Update Date:2022-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services