Provider Demographics
NPI:1134874902
Name:LEON, EMILY (LGPC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:LEON
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LGPC
Mailing Address - Street 1:263 WEST PATRICK ST. #1
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701
Mailing Address - Country:US
Mailing Address - Phone:240-457-9477
Mailing Address - Fax:
Practice Address - Street 1:263 WEST PATRICK ST. #1
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701
Practice Address - Country:US
Practice Address - Phone:240-457-9477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-19
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP12065101YP2500X
MDLC16017101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty