Provider Information for 1154625077
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CRAIG MAYNOR LEECH LMHC, LPC
Sex: Male
NPI: 1154625077
Last Updated: 2024-07-08
Certification Date: 2024-07-08
Certification Date: 2024-07-08
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1154625077 | ||||||||||||
| Enumeration Date | 2011-01-06 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 9329 MANDRAKE CT TAMPA, FL 33647-3290 United States Phone: 813-494-2226 | Fax: | ||||||||||||
| Primary Practice Address | 151 EDGEWOOD DR CHAPIN, SC 29036-8154 United States Phone: 813-494-2226 | Fax: | ||||||||||||
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