Provider Demographics
NPI:1215300041
Name:WILLIAMSON, LEAH
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:FOGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:39610 RANCH PL
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-8630
Mailing Address - Country:US
Mailing Address - Phone:907-600-1684
Mailing Address - Fax:907-308-5882
Practice Address - Street 1:609 MARINE AVE
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-6948
Practice Address - Country:US
Practice Address - Phone:076-001-6849
Practice Address - Fax:907-308-5882
Is Sole Proprietor?:No
Enumeration Date:2015-11-02
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099295931041C0700X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical