Provider Demographics
NPI:1487394904
Name:LEUNG, GRACE (BCBA)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:LEUNG
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 8TH ST NW # NA
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-7909
Mailing Address - Country:US
Mailing Address - Phone:443-752-4409
Mailing Address - Fax:
Practice Address - Street 1:15245 SHADY GROVE RD STE 320
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6280
Practice Address - Country:US
Practice Address - Phone:301-882-6060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1-22-58448103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty