Healthcare Provider Details

I. General information

NPI: 1346937109
Provider Name (Legal Business Name): LEAH MARIE VANDINE QMHS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2023
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17951 JEFFERSON PARK RD STE 100
MIDDLEBURG HEIGHTS OH
44130-8439
US

IV. Provider business mailing address

2321 OAK PARK AVE
CLEVELAND OH
44109-5423
US

V. Phone/Fax

Practice location:
  • Phone: 440-879-8517
  • Fax: 440-445-0879
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2607353
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: