Provider Demographics
NPI:1659092807
Name:TRAORE, LEONIDAS (LCDC-I)
Entity Type:Individual
Prefix:MS
First Name:LEONIDAS
Middle Name:
Last Name:TRAORE
Suffix:
Gender:F
Credentials:LCDC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 SIERRA ESTATE TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76119-2663
Mailing Address - Country:US
Mailing Address - Phone:682-518-4508
Mailing Address - Fax:
Practice Address - Street 1:4801 BRENTWOOD STAIR RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76103-1729
Practice Address - Country:US
Practice Address - Phone:817-492-9383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)