Provider Demographics
NPI:1467049247
Name:LEEKS, STAR LAFAITH
Entity Type:Individual
Prefix:MRS
First Name:STAR
Middle Name:LAFAITH
Last Name:LEEKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 555
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-0555
Mailing Address - Country:US
Mailing Address - Phone:225-266-7499
Mailing Address - Fax:
Practice Address - Street 1:1000 SUNSET BLVD STE 140
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-5482
Practice Address - Country:US
Practice Address - Phone:916-784-6436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10923101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health