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Individual

LEIGH DIOTALEVI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LISW-CP

Contact information

Practice address
149 RIVERWALK BLVD STE 11, RIDGELAND, SC 29936-8191
(843) 636-5017
(843) 278-9198
Mailing address
149 RIVERWALK BLVD STE 11, RIDGELAND, SC 29936-8191
(438) 636-5017
(843) 278-9198

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
1041C0700X
Clinical Social Worker
Primary
11563
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
SW1478
SC
Enumeration date
01/27/2016
Last updated
04/16/2018
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