Provider Demographics
NPI:1154625077
Name:LEECH, CRAIG MAYNOR (LMHC, LPC)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:MAYNOR
Last Name:LEECH
Suffix:
Gender:M
Credentials:LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9329 MANDRAKE CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3290
Mailing Address - Country:US
Mailing Address - Phone:813-494-2226
Mailing Address - Fax:
Practice Address - Street 1:151 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036-8154
Practice Address - Country:US
Practice Address - Phone:813-494-2226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-06
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 10230101YM0800X
SC9733101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional