Individual provider Active NPI

Ellen Kathleen Labgold, LCSW

  • Clinical Social Worker
  • Leesburg, VA
National Provider Identifier
1104391622
Registry record updated Jan 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
0904012586 Issued in VA
Practice address
102 Heritage Way NE Ste 302
Leesburg, VA 20176-4544
Phone
(703) 771-5100
Fax
(703) 777-0170
NPI assigned
Oct 11, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 5, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 0904012586 VA Primary

Addresses

Primary practice location

102 Heritage Way NE Ste 302
Leesburg, VA 20176-4544

Mailing address

PO Box 7400
Leesburg, VA 20177-7400
Phone (703) 771-5100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Yes, effective Jul 1, 2026 through Jul 1, 2028

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

2 Cardinal Park Dr SE
Suite 105a
Leesburg, VA 20175-4448

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Southlight Counseling PLLC CurrentSince Jun 1, 2022 Accepting new patients

Locations

19420 Golf Vista Plz
Ste 230B
Lansdowne, VA 20176
Phone (571) 233-2302

2 Cardinal Park Dr SE
Ste 105A
Leesburg, VA 20175
Phone (571) 233-2302

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1539216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609804800000",
    "number": "1104391622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7400",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201777400",
            "telephone_number": "703-771-5100",
            "fax_number": "703-777-0170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 HERITAGE WAY NE STE 302",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201764544",
            "telephone_number": "703-771-5100",
            "fax_number": "703-777-0170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LABGOLD",
        "first_name": "ELLEN",
        "middle_name": "KATHLEEN",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-10-11",
        "last_updated": "2021-01-05",
        "certification_date": "2021-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904012586",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Leesburg, VA

Sources for this page

Verify at the official NPI Registry.