Provider Demographics
NPI:1154944601
Name:BLEICH, LEONA LIN
Entity type:Individual
Prefix:
First Name:LEONA
Middle Name:LIN
Last Name:BLEICH
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 1:610 RIDLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-2236
Mailing Address - Country:US
Mailing Address - Phone:706-884-5050
Mailing Address - Fax:706-884-5056
Practice Address - Street 1:610 RIDLEY AVE
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-2236
Practice Address - Country:US
Practice Address - Phone:706-884-5050
Practice Address - Fax:706-884-5056
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional