Individual
CAROL ANNETTE LEAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6450 SOUTHCENTER BLVD, TUKWILA, WA 98188-2552
(206) 466-5012
(206) 453-4404
Mailing address
PO BOX 2429, LONGVIEW, WA 98632-8486
(360) 353-9494
(360) 353-9440
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP61215945
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2382777448
—
NC
Enumeration date
01/10/2020
Last updated
10/31/2023
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