Provider Demographics
NPI:1457805202
Name:RAGAN, LEIGH S (LCADC)
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:S
Last Name:RAGAN
Suffix:
Gender:F
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 FOREST DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-1482
Mailing Address - Country:US
Mailing Address - Phone:410-280-2333
Mailing Address - Fax:
Practice Address - Street 1:1419 FOREST DR
Practice Address - Street 2:SUITE 102
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-1482
Practice Address - Country:US
Practice Address - Phone:410-280-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-10
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA026101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)