Provider Demographics
NPI:1154081750
Name:NEW LEAF THERAPEUTICS & CONSULTING
Entity Type:Organization
Organization Name:NEW LEAF THERAPEUTICS & CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:PAIGE
Authorized Official - Last Name:FORSHAY-RODEFER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:478-227-0993
Mailing Address - Street 1:1266 WAVERLAND DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31211-1322
Mailing Address - Country:US
Mailing Address - Phone:850-294-0047
Mailing Address - Fax:
Practice Address - Street 1:2080 INGLESIDE AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-2028
Practice Address - Country:US
Practice Address - Phone:478-227-0993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)