Provider Demographics
NPI:1477965499
Name:TOLWIN, LEAH
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:
Last Name:TOLWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LINDAGWENN
Other - Middle Name:
Other - Last Name:MAYER-TOLWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:26278 CASTLETON DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-4708
Mailing Address - Country:US
Mailing Address - Phone:248-953-0503
Mailing Address - Fax:
Practice Address - Street 1:26278 CASTLETON DR
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-4708
Practice Address - Country:US
Practice Address - Phone:248-953-0503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-25
Last Update Date:2014-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010727081041C0700X
CALCS116551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical