Provider Demographics
NPI:1578641932
Name:FORD, LEILA A (PHD)
Entity Type:Individual
Prefix:MS
First Name:LEILA
Middle Name:A
Last Name:FORD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 HEATHER HOLLOW CIRCLE
Mailing Address - Street 2:13
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2358
Mailing Address - Country:US
Mailing Address - Phone:301-593-4766
Mailing Address - Fax:
Practice Address - Street 1:14440 CHERRY LANE COURT
Practice Address - Street 2:SUITE 218
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707
Practice Address - Country:US
Practice Address - Phone:301-490-1011
Practice Address - Fax:301-490-1484
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04278103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist