Provider Demographics
NPI:1033701156
Name:LEIGHTON, LUANN R
Entity Type:Individual
Prefix:
First Name:LUANN
Middle Name:R
Last Name:LEIGHTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4214 SUMMER SHADE WAY
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4872
Mailing Address - Country:US
Mailing Address - Phone:443-838-6184
Mailing Address - Fax:
Practice Address - Street 1:4214 SUMMER SHADE WAY
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4872
Practice Address - Country:US
Practice Address - Phone:443-838-6184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTBD320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities