Provider Demographics
NPI:1447323167
Name:LEISTER, MAUREEN KIRBY (LPC)
Entity type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:KIRBY
Last Name:LEISTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4540 CENTRALIA RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-1121
Mailing Address - Country:US
Mailing Address - Phone:804-536-3884
Mailing Address - Fax:804-733-8502
Practice Address - Street 1:230 SOUTH CRATER RD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-4424
Practice Address - Country:US
Practice Address - Phone:804-733-2180
Practice Address - Fax:804-733-8502
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002686101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA262826OtherANTHEM BLUE CROSS BLUE SH
VA089394OtherSENTARA
VA3033951OtherAETNA