Organization
CAROL A LOVE LEACH, M.A., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL A LEACH MA (OWNER)
(248) 830-6357
Entity
Organization
Contact information
Practice address
5665 W MAPLE RD STE A, WEST BLOOMFIELD, MI 48322-3741
(248) 830-6357
(248) 626-8836
Mailing address
260 HICKORY LN, WATERFORD, MI 48327-2570
(248) 830-6357
(248) 626-8836
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11712865
CAQH
—
Enumeration date
04/21/2022
Last updated
04/21/2022
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