Provider Demographics
NPI:1982089546
Name:LEGER, LEO (LADC)
Entity Type:Individual
Prefix:
First Name:LEO
Middle Name:
Last Name:LEGER
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 793
Mailing Address - Street 2:
Mailing Address - City:CAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03223-0793
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27 TERRACE ROAD
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:NH
Practice Address - Zip Code:03285
Practice Address - Country:US
Practice Address - Phone:603-726-8092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0330101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)