Provider Demographics
NPI:1447936877
Name:HUGHES, LEROY ANTHONY (MA, RESIDENT IN COUN)
Entity type:Individual
Prefix:MR
First Name:LEROY
Middle Name:ANTHONY
Last Name:HUGHES
Suffix:
Gender:M
Credentials:MA, RESIDENT IN COUN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-5249
Mailing Address - Country:US
Mailing Address - Phone:804-385-6117
Mailing Address - Fax:
Practice Address - Street 1:10623 JONES ST STE 301B
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7512
Practice Address - Country:US
Practice Address - Phone:703-997-6641
Practice Address - Fax:540-390-0002
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704015925101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health