Provider Demographics
NPI:1952967945
Name:MCKENZIE, LEAH (CDCA)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4617 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-3817
Mailing Address - Country:US
Mailing Address - Phone:513-401-4351
Mailing Address - Fax:
Practice Address - Street 1:7593 TYLERS PLACE BLVD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-6308
Practice Address - Country:US
Practice Address - Phone:513-909-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.167679101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)