Provider Demographics
NPI:1396955175
Name:NORTHRUP, R LEIGH (LCSW)
Entity type:Individual
Prefix:MS
First Name:R
Middle Name:LEIGH
Last Name:NORTHRUP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:LEIGH
Other - Middle Name:
Other - Last Name:NORTHRUP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:8000 PACE RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-3424
Mailing Address - Country:US
Mailing Address - Phone:757-480-5040
Mailing Address - Fax:
Practice Address - Street 1:7460 TIDEWATER DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-3845
Practice Address - Country:US
Practice Address - Phone:757-664-6670
Practice Address - Fax:757-664-6678
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904003572101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)