Provider Demographics
NPI:1881397883
Name:CHURCH, LEAH
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:CHURCH
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 1:1065 PINE RIVER POND RD
Mailing Address - Street 2:
Mailing Address - City:SANBORNVILLE
Mailing Address - State:NH
Mailing Address - Zip Code:03872-3349
Mailing Address - Country:US
Mailing Address - Phone:774-955-7422
Mailing Address - Fax:
Practice Address - Street 1:1065 PINE RIVER POND RD
Practice Address - Street 2:
Practice Address - City:SANBORNVILLE
Practice Address - State:NH
Practice Address - Zip Code:03872-3349
Practice Address - Country:US
Practice Address - Phone:774-955-7422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)