Provider Demographics
NPI:1326783457
Name:LEEPER, NICOLE ANN
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANN
Last Name:LEEPER
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 1:38 IAMS HILL RD
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:PA
Mailing Address - Zip Code:15345-1065
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7 GLASSWORKS RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:PA
Practice Address - Zip Code:15338-9507
Practice Address - Country:US
Practice Address - Phone:724-943-3308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor