Provider Demographics
NPI:1720084965
Name:VANASSE, LEON DONALD (LCPC)
Entity Type:Individual
Prefix:MR
First Name:LEON
Middle Name:DONALD
Last Name:VANASSE
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 ORLEANS ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-1020
Mailing Address - Country:US
Mailing Address - Phone:410-558-4747
Mailing Address - Fax:410-732-0185
Practice Address - Street 1:2323 ORLEANS ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-1020
Practice Address - Country:US
Practice Address - Phone:410-558-4747
Practice Address - Fax:410-732-0185
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0985101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
S732Medicare UPIN