# JUSTIN LEAHY CRNP-PMH LL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316585508
- **Authorized official:** MR. JUSTIN P LEAHY CRNP-PMH (OWNER)
- **Authorized official phone:** (410) 562-2867

## Contact information

- **Practice address:** 4353 ENSBROOK LN, WOODBRIDGE, VA 22193-2652
- **Practice address phone:** (410) 562-2867
- **Mailing address:** 1812 E REGENTS PARK RD, CROFTON, MD 21114-2528
- **Mailing address phone:** (410) 562-2867

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 12/18/2019
- **Last updated:** 12/18/2019