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Organization

JUSTIN LEAHY CRNP-PMH LL

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. JUSTIN P LEAHY CRNP-PMH (OWNER)
(410) 562-2867
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary

Other

Enumeration date
12/18/2019
Last updated
12/18/2019
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