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Individual

BIANCA LEON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
715 LILAC MIST DR, LOGANVILLE, GA 30052-3061
(470) 236-9864
Mailing address
265 W PIKE ST STE 3, LAWRENCEVILLE, GA 30046-4896
(470) 236-9864

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary

Other

Enumeration date
01/07/2025
Last updated
01/07/2025
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