Provider Demographics
NPI:1235363250
Name:LEATHERWOOD, GINGER LUANNE
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:LUANNE
Last Name:LEATHERWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GINGER
Other - Middle Name:
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:1202 SW A AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-3821
Mailing Address - Country:US
Mailing Address - Phone:580-357-8114
Mailing Address - Fax:580-357-0079
Practice Address - Street 1:1202 SW A AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-3821
Practice Address - Country:US
Practice Address - Phone:580-357-8114
Practice Address - Fax:580-357-0079
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)