Provider Demographics
NPI:1275719148
Name:LEIGHOW, AMBER DAWN (RC, CPHT)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:DAWN
Last Name:LEIGHOW
Suffix:
Gender:F
Credentials:RC, CPHT
Other - Prefix:MRS
Other - First Name:AMBER
Other - Middle Name:DAWN
Other - Last Name:ERNEST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:105 CREDES LNDG
Mailing Address - Street 2:
Mailing Address - City:ELKVIEW
Mailing Address - State:WV
Mailing Address - Zip Code:25071-8185
Mailing Address - Country:US
Mailing Address - Phone:304-965-7979
Mailing Address - Fax:304-965-3239
Practice Address - Street 1:105 CREDES LNDG
Practice Address - Street 2:
Practice Address - City:ELKVIEW
Practice Address - State:WV
Practice Address - Zip Code:25071-8185
Practice Address - Country:US
Practice Address - Phone:304-965-7979
Practice Address - Fax:304-965-3239
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00060126101YP2500X
WAVB00066006183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No183700000XPharmacy Service ProvidersPharmacy Technician