Provider Demographics
NPI:1609662907
Name:HIMES, LEAH R (LLMSW)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:R
Last Name:HIMES
Suffix:
Gender:
Credentials:LLMSW
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:R
Other - Last Name:WIECZOREK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:411 ELLEN AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-3317
Mailing Address - Country:US
Mailing Address - Phone:586-265-3686
Mailing Address - Fax:
Practice Address - Street 1:22170 W 9 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-6007
Practice Address - Country:US
Practice Address - Phone:248-485-8650
Practice Address - Fax:248-213-9959
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI171M00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator