Provider Demographics
NPI:1720581903
Name:HAZELTON, LEIGH ANN (TCADC)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:ANN
Last Name:HAZELTON
Suffix:
Gender:F
Credentials:TCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 PRIVATE DRIVE 1440
Mailing Address - Street 2:
Mailing Address - City:SOUTH POINT
Mailing Address - State:OH
Mailing Address - Zip Code:45680-7747
Mailing Address - Country:US
Mailing Address - Phone:606-369-4274
Mailing Address - Fax:
Practice Address - Street 1:2001 SCIOTO TRL
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2845
Practice Address - Country:US
Practice Address - Phone:740-925-9259
Practice Address - Fax:740-991-6006
Is Sole Proprietor?:No
Enumeration Date:2018-03-14
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)