Healthcare Provider Details

I. General information

NPI: 1629932736
Provider Name (Legal Business Name): LEIGHA DANIELLE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 TRADERS CROSS FL 1
BLUFFTON SC
29909-4637
US

IV. Provider business mailing address

300 PRESERVE AVE E
PORT ROYAL SC
29935-1666
US

V. Phone/Fax

Practice location:
  • Phone: 989-225-6085
  • Fax:
Mailing address:
  • Phone: 608-289-8904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: