Basic Information
| Provider Information | |||||||||
| NPI: | 1013062314 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEIS | ||||||||
| FirstName: | ARLEEN | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | LCSW-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9030 STATE ROUTE 108 | ||||||||
| Address2: | OAKLAND CENTER | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210451951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107401901 | ||||||||
| FaxNumber: | 4107402503 | ||||||||
| Practice Location | |||||||||
| Address1: | 9030 STATE ROUTE 108 | ||||||||
| Address2: | OAKLAND CENTER | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210451951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107401901 | ||||||||
| FaxNumber: | 4107402503 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 01242 | MD | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.