Provider Demographics
NPI:1982176939
Name:LEONARD, ALLISON MALIA (MA, QMHP)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:MALIA
Last Name:LEONARD
Suffix:
Gender:F
Credentials:MA, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 RIMINGTON LN APT 309
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2134
Mailing Address - Country:US
Mailing Address - Phone:678-350-3964
Mailing Address - Fax:
Practice Address - Street 1:309 RIMINGTON LN APT 309
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2134
Practice Address - Country:US
Practice Address - Phone:678-350-3964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-31
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IL149.0234031041C0700X
GACSW0078161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health