Provider Demographics
NPI:1396817680
Name:PETERSON, LEIGH ANN (LPC, CEAP, SAP)
Entity Type:Individual
Prefix:
First Name:LEIGH ANN
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LPC, CEAP, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 CLAIRMEADE VALLEY RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-1052
Mailing Address - Country:US
Mailing Address - Phone:770-997-8516
Mailing Address - Fax:770-991-9014
Practice Address - Street 1:1631 PHOENIX BLVD
Practice Address - Street 2:SUITE 9
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-5545
Practice Address - Country:US
Practice Address - Phone:770-997-8516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000691101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional