Provider Demographics
NPI:1588334544
Name:SANKOFA, LEON ANDREW SR (LCSW)
Entity type:Individual
Prefix:MR
First Name:LEON
Middle Name:ANDREW
Last Name:SANKOFA
Suffix:SR
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:PO BOX 7502
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-0502
Mailing Address - Country:US
Mailing Address - Phone:757-380-0385
Mailing Address - Fax:757-380-0385
Practice Address - Street 1:3001 W MERCURY BLVD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-3930
Practice Address - Country:US
Practice Address - Phone:757-380-0385
Practice Address - Fax:757-380-0385
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1110501041C0700X
VA390200000X
VA09040133091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty