Provider Demographics
NPI:1811065402
Name:ANANIA, LEITH D (LMFT)
Entity type:Individual
Prefix:MRS
First Name:LEITH
Middle Name:D
Last Name:ANANIA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:LEITH
Other - Middle Name:ANN
Other - Last Name:DAVENPORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:100 RENEE DR
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-6180
Mailing Address - Country:US
Mailing Address - Phone:912-674-0872
Mailing Address - Fax:
Practice Address - Street 1:694 E WILLIAM AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-5024
Practice Address - Country:US
Practice Address - Phone:912-674-0872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT000906106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA887021585AMedicaid