Healthcare Provider Details

I. General information

NPI: 1356223614
Provider Name (Legal Business Name): LEANDRA PREMPEH PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2025
Last Update Date: 07/25/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 N DRUID HILLS RD NE
ATLANTA GA
30329-3117
US

IV. Provider business mailing address

3721 WEEPING WAY
STOCKBRIDGE GA
30281-5687
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-1479
  • Fax:
Mailing address:
  • Phone: 678-907-5694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number00000
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: