Provider Demographics
NPI:1275270290
Name:GANSSLE, LEAH BRIELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:BRIELLE
Last Name:GANSSLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6018 CHESTNUT HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-3042
Mailing Address - Country:US
Mailing Address - Phone:571-643-2606
Mailing Address - Fax:
Practice Address - Street 1:6018 CHESTNUT HOLLOW CT
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-3042
Practice Address - Country:US
Practice Address - Phone:571-643-2606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040139161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical