Provider Demographics
NPI:1699989962
Name:LEASE, ANNA LEITER (LCPC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:LEITER
Last Name:LEASE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11628 OLD ANNAPOLIS RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-3432
Mailing Address - Country:US
Mailing Address - Phone:301-865-5408
Mailing Address - Fax:
Practice Address - Street 1:703 W PATRICK ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4029
Practice Address - Country:US
Practice Address - Phone:301-662-8908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1370101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health