Provider Demographics
NPI:1699062901
Name:LEBEDA, KATHERINE J (LCSW)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:J
Last Name:LEBEDA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18354 FAIRWAY OAKS SQ
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8460
Mailing Address - Country:US
Mailing Address - Phone:703-585-4107
Mailing Address - Fax:703-737-3922
Practice Address - Street 1:1 E MARKET ST
Practice Address - Street 2:SUITE 201
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-3014
Practice Address - Country:US
Practice Address - Phone:703-585-4107
Practice Address - Fax:703-737-3922
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040040321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010215226Medicaid