Healthcare Provider Details

I. General information

NPI: 1770972218
Provider Name (Legal Business Name): MARY THERESA LEONE M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2015
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 E WILCOX AVE
WHITE CLOUD MI
49349-8794
US

IV. Provider business mailing address

520 COBB ST
CADILLAC MI
49601-2588
US

V. Phone/Fax

Practice location:
  • Phone: 231-689-5943
  • Fax: 231-689-1590
Mailing address:
  • Phone: 231-689-5943
  • Fax: 231-689-1590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401017941
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: