Provider Demographics
NPI:1275647224
Name:LEAVER, VINCENT WAYNE (LMHC)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:WAYNE
Last Name:LEAVER
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4025 SANDLEWOOD LANE
Mailing Address - Street 2:UNIT 4
Mailing Address - City:FT MYRES
Mailing Address - State:FL
Mailing Address - Zip Code:33907-4646
Mailing Address - Country:US
Mailing Address - Phone:239-275-3097
Mailing Address - Fax:
Practice Address - Street 1:9470 HEALTH PARK CIRCLE
Practice Address - Street 2:HOPE HOSPICE
Practice Address - City:FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3600
Practice Address - Country:US
Practice Address - Phone:239-489-9156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4346101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health