Provider Demographics
NPI:1417426735
Name:IRVING, LEONARD JAMES SR (CDP)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:JAMES
Last Name:IRVING
Suffix:SR
Gender:M
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3407 S 253RD ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-9746
Mailing Address - Country:US
Mailing Address - Phone:253-529-2511
Mailing Address - Fax:
Practice Address - Street 1:3407 S 253RD ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-9746
Practice Address - Country:US
Practice Address - Phone:253-529-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)