Individual
ASIA VIANNA MACK LEAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
529 14TH ST NW, WASHINGTON, DC 20045-1000
(202) 986-5941
Mailing address
94 WEBSTER ST NE APT 2, WASHINGTON, DC 20011-4961
(404) 934-5214
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LGP9539
MD
101YM0800X
Mental Health Counselor
Primary
LGPC00541
DC
Other
Enumeration date
10/01/2020
Last updated
10/01/2020
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