Individual
AMBER LEICHTLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW LADAC
Contact information
Practice address
1122 INDUSTRIAL PARK RD, ESPANOLA, NM 87532-3453
(505) 753-3143
Mailing address
1122 INDUSTRIAL PARK RD, ESPANOLA, NM 87532-3453
(505) 753-3143
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0071001
NM
101YM0800X
Mental Health Counselor
Primary
M-04710
NM
Other
Enumeration date
09/25/2009
Last updated
09/25/2009
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