MEDICARE: LEONKA GARVIN PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	1807	SC

General Provider Information

NPI Number	:	1588478721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONKA GARVIN PSY.D.

Provider Business Mailing Address
First Line	:	8113 BAY SPRINGS RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-2579
Country	:	US
Telephone Number	:	803-842-9212
Fax Number	:

Provider Business Practice Location Address
First Line	:	4546 BROAD RIVER RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29210-4014
Country	:	US
Telephone Number	:	803-545-0307
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2025
Last Update Date	:	02/06/2025

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