Provider Demographics
NPI:1750846804
Name:LEIVA-DIBAN, PILAR NATALIA (LCSW)
Entity Type:Individual
Prefix:
First Name:PILAR
Middle Name:NATALIA
Last Name:LEIVA-DIBAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PILAR
Other - Middle Name:NATALIA
Other - Last Name:HENDRIKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:109 N GARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-2605
Mailing Address - Country:US
Mailing Address - Phone:702-420-4129
Mailing Address - Fax:
Practice Address - Street 1:46050 MANEKIN PLZ STE 110
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-6519
Practice Address - Country:US
Practice Address - Phone:571-665-6723
Practice Address - Fax:571-665-6720
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040101211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical