Provider Demographics
NPI:1609998780
Name:LEON, SUSAN (RAS, SACII)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:LEON
Suffix:
Gender:F
Credentials:RAS, SACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1067 OAKHURST WAY
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-2030
Mailing Address - Country:US
Mailing Address - Phone:209-478-5314
Mailing Address - Fax:
Practice Address - Street 1:620 N AURORA ST STE 2
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-2276
Practice Address - Country:US
Practice Address - Phone:209-468-9600
Practice Address - Fax:209-468-9611
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)