Provider Demographics
NPI:1760593321
Name:LEEKS, JOHN (LICDC, SAP, CADC II)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:LEEKS
Suffix:
Gender:M
Credentials:LICDC, SAP, CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2829 WATT AVE
Mailing Address - Street 2:150
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-6200
Mailing Address - Country:US
Mailing Address - Phone:916-333-4992
Mailing Address - Fax:916-817-3502
Practice Address - Street 1:2829 WATT AVE
Practice Address - Street 2:150
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-6200
Practice Address - Country:US
Practice Address - Phone:916-333-4992
Practice Address - Fax:916-817-3502
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH83950101YA0400X
CARA854007101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)