Provider Demographics
NPI:1679450480
Name:LEACH, GREGORY (MED LADC I)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:
Last Name:LEACH
Suffix:
Gender:M
Credentials:MED LADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 EVERGREEN VLY
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2025
Mailing Address - Country:US
Mailing Address - Phone:603-988-5885
Mailing Address - Fax:
Practice Address - Street 1:7 EVERGREEN VLY
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2025
Practice Address - Country:US
Practice Address - Phone:603-988-5885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18649101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)