Provider Demographics
NPI:1215278791
Name:HUPALO, LEANN MARIE (LPC, LSATP)
Entity type:Individual
Prefix:MS
First Name:LEANN
Middle Name:MARIE
Last Name:HUPALO
Suffix:
Gender:F
Credentials:LPC, LSATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 SHARON RD STE 203
Mailing Address - Street 2:
Mailing Address - City:KING WILLIAM
Mailing Address - State:VA
Mailing Address - Zip Code:23086-3344
Mailing Address - Country:US
Mailing Address - Phone:804-398-8401
Mailing Address - Fax:
Practice Address - Street 1:1041 SHARON RD STE 203
Practice Address - Street 2:
Practice Address - City:KING WILLIAM
Practice Address - State:VA
Practice Address - Zip Code:23086-3344
Practice Address - Country:US
Practice Address - Phone:804-398-8401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-08
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005406101YM0800X
VA0718000295101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0701005406OtherSTATE LIC. FROM COMM. OF VA DEPT OF HEALTH PROFESSIONS BOARD OF COUNSELING
VA0718000295OtherSTATE LIC. FROM COMM. OF VA DEPT OF HEALTH PROFESSIONS BOARD OF COUNSELING