Organization
LEESBURG COMMUNITY CHURCH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY J TEAGUE PH.D. (DIRECTOR)
(703) 777-2209
Entity
Organization
Contact information
Practice address
815 LEE AVE SW STE B, LEESBURG, VA 20175-3416
(703) 777-2209
Mailing address
835 LEE AVE SW, LEESBURG, VA 20175-3416
(703) 777-2209
(703) 779-2018
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0701001459
VA
Other
Enumeration date
03/29/2011
Last updated
03/29/2011
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