Provider Demographics
NPI:1649776287
Name:RALEY, LEAH
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:
Last Name:RALEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:FAULKNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:807 DONNELL BLVD STE Q
Mailing Address - Street 2:
Mailing Address - City:DALEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36322-2111
Mailing Address - Country:US
Mailing Address - Phone:334-709-4386
Mailing Address - Fax:
Practice Address - Street 1:807 DONNELL BLVD STE Q
Practice Address - Street 2:
Practice Address - City:DALEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36322-2111
Practice Address - Country:US
Practice Address - Phone:334-709-4386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst