| Carol A Love Leach, M.a., P.c. | |
|
5665 W Maple Rd Ste A West Bloomfield MI 48322-3741 | |
| (248) 830-6357 | |
| (248) 626-8836 |
| Full Name | Carol A Love Leach, M.a., P.c. |
|---|---|
| Speciality | Psychologist |
| Location | 5665 W Maple Rd Ste A, West Bloomfield, Michigan |
| Authorized Official Name and Position | Carol A Leach (OWNER) |
| Authorized Official Contact | 2488306357 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carol A Love Leach, M.a., P.c. 260 Hickory Ln Waterford MI 48327-2570 Ph: (248) 830-6357 | Carol A Love Leach, M.a., P.c. 5665 W Maple Rd Ste A West Bloomfield MI 48322-3741 Ph: (248) 830-6357 |
| NPI Number | 1962146449 |
|---|---|
| Provider Enumeration Date | 04/21/2022 |
| Last Update Date | 04/21/2022 |
| Certification Date | 03/14/2022 |
| Medicare PECOS PAC ID | 2567904519 |
|---|---|
| Medicare Enrollment ID | O20240606001005 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962146449 | NPI | - | NPPES |
| 11712865 | Other | CAQH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Carol Ann Love Leach |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1114931615 PECOS PAC ID: 3476095423 Enrollment ID: I20240606001082 |
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