Provider Demographics
NPI:1619516945
Name:LEAPHART, PERRI
Entity Type:Individual
Prefix:
First Name:PERRI
Middle Name:
Last Name:LEAPHART
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 1:460 PIN OAK DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-7916
Mailing Address - Country:US
Mailing Address - Phone:803-714-3446
Mailing Address - Fax:803-824-6189
Practice Address - Street 1:460 PIN OAK DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-7916
Practice Address - Country:US
Practice Address - Phone:803-714-3446
Practice Address - Fax:803-824-6189
Is Sole Proprietor?:No
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORBT-19-96934106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician