Provider Demographics
NPI:1205547130
Name:MA, XUAN LEAH
Entity type:Individual
Prefix:MS
First Name:XUAN
Middle Name:LEAH
Last Name:MA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5548 HILLIAARD ROME OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-7386
Mailing Address - Country:US
Mailing Address - Phone:614-879-8067
Mailing Address - Fax:614-503-0899
Practice Address - Street 1:5548 HILLIAARD ROME OFFICE PARK
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-7386
Practice Address - Country:US
Practice Address - Phone:614-879-8067
Practice Address - Fax:614-503-0899
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC2406242101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health