Provider Demographics
NPI:1912549890
Name:LEACH, ERIN (LCPC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:LEACH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 RIDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-2937
Mailing Address - Country:US
Mailing Address - Phone:410-459-8111
Mailing Address - Fax:
Practice Address - Street 1:626 RIDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-2937
Practice Address - Country:US
Practice Address - Phone:410-459-8111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-12
Last Update Date:2019-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4008101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional