Provider Demographics
NPI:1063179075
Name:WINGO, LEROY STERLING III (LCSW)
Entity type:Individual
Prefix:
First Name:LEROY
Middle Name:STERLING
Last Name:WINGO
Suffix:III
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21430 TIMBERLAKE RD # 103
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-7248
Mailing Address - Country:US
Mailing Address - Phone:434-515-1164
Mailing Address - Fax:
Practice Address - Street 1:21430 TIMBERLAKE RD # 103
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-7248
Practice Address - Country:US
Practice Address - Phone:434-515-1164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-24
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040134651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical