Provider Demographics
NPI:1912675208
Name:DE LEON, MADISON NICOLE (LCSW, LICSW)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:NICOLE
Last Name:DE LEON
Suffix:
Gender:
Credentials:LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10530 LINDEN LAKE PLZ STE 200
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-6434
Mailing Address - Country:US
Mailing Address - Phone:703-496-7804
Mailing Address - Fax:571-359-6784
Practice Address - Street 1:10530 LINDEN LAKE PLZ STE 200
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-6434
Practice Address - Country:US
Practice Address - Phone:703-496-7804
Practice Address - Fax:571-359-6784
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009470271041C0700X
VA09040132461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical