Provider Demographics
NPI:1316682289
Name:RYDEL, LEAH
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:RYDEL
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 1:166 ELYSIAN WAY NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-1084
Mailing Address - Country:US
Mailing Address - Phone:770-317-0305
Mailing Address - Fax:
Practice Address - Street 1:5755 N POINT PKWY STE 280
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-1176
Practice Address - Country:US
Practice Address - Phone:770-810-5261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health