Basic Information
| Provider Information | |||||||||
| NPI: | 1811248941 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATRICK | ||||||||
| FirstName: | LEAH | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7400 ROPER LANE | ||||||||
| Address2: | |||||||||
| City: | DAPHNE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 36526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2513786500 | ||||||||
| FaxNumber: | 2513786563 | ||||||||
| Practice Location | |||||||||
| Address1: | 7400 ROPER LANE | ||||||||
| Address2: | |||||||||
| City: | DAPHNE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 36526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2513786500 | ||||||||
| FaxNumber: | 2513786563 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2012 | ||||||||
| LastUpdateDate: | 09/28/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 2657 | AL | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.