Provider Demographics
NPI:1699197327
Name:TOLLINI, LEAH (LLBSW, LLMSW, QMHP)
Entity Type:Individual
Prefix:MS
First Name:LEAH
Middle Name:
Last Name:TOLLINI
Suffix:
Gender:F
Credentials:LLBSW, LLMSW, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3430 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2202
Mailing Address - Country:US
Mailing Address - Phone:313-832-3100
Mailing Address - Fax:313-832-5271
Practice Address - Street 1:3430 3RD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2202
Practice Address - Country:US
Practice Address - Phone:313-832-3100
Practice Address - Fax:313-832-5271
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010957501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical