Provider Demographics
NPI:1780013540
Name:LEIVA, CAROL VANESSA (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:VANESSA
Last Name:LEIVA
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12212 ATHERTON DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-1006
Mailing Address - Country:US
Mailing Address - Phone:202-316-6937
Mailing Address - Fax:
Practice Address - Street 1:12212 ATHERTON DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-1006
Practice Address - Country:US
Practice Address - Phone:202-316-6937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-02
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC200001560101YP2500X
VA0701010913101YP2500X
MDLC7303101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLGP5228OtherSTATE LICENSE NUMBER