Healthcare Provider Details

I. General information

NPI: 1083521645
Provider Name (Legal Business Name): ANNA LEROY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 POWERS FERRY RD SE STE 200
MARIETTA GA
30067-5491
US

IV. Provider business mailing address

4512 KARRON LN
POWDER SPGS GA
30127-3349
US

V. Phone/Fax

Practice location:
  • Phone: 678-540-4757
  • Fax:
Mailing address:
  • Phone: 470-232-6444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC010874
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: