Provider Demographics
NPI:1285442962
Name:LEEKS, VIRGINIA (LPC)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:
Last Name:LEEKS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1101 BOMBAY LN
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-5832
Mailing Address - Country:US
Mailing Address - Phone:678-674-8835
Mailing Address - Fax:
Practice Address - Street 1:1101 BOMBAY LN
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5832
Practice Address - Country:US
Practice Address - Phone:678-674-8835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC015194101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health