Individual
CRYSTAL ODESSA LEONARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
183 SEABREEZE CT, NEWNAN, GA 30265-5572
(317) 847-8836
Mailing address
183 SEABREEZE CT, NEWNAN, GA 30265-5572
(317) 847-8836
Taxonomy
Speciality
Code
Description
License number
State
103TE1100X
Exercise & Sports Psychologist
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
261QS100X
N/A
GA
Enumeration date
09/28/2020
Last updated
05/24/2021
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