Provider Demographics
NPI:1780233148
Name:LEONARD, CHASITY (CDCA)
Entity Type:Individual
Prefix:MISS
First Name:CHASITY
Middle Name:
Last Name:LEONARD
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3943 LONG DR APT A
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-9530
Mailing Address - Country:US
Mailing Address - Phone:330-232-1455
Mailing Address - Fax:
Practice Address - Street 1:3943 LONG DR APT A
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:OH
Practice Address - Zip Code:44203-9530
Practice Address - Country:US
Practice Address - Phone:330-232-1455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171371101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty