Healthcare Provider Details

I. General information

NPI: 1275719148
Provider Name (Legal Business Name): AMBER DAWN LEIGHOW RC, CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. AMBER DAWN ERNEST

II. Dates (important events)

Enumeration Date: 01/10/2008
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 CREDES LNDG
ELKVIEW WV
25071-8185
US

IV. Provider business mailing address

105 CREDES LNDG
ELKVIEW WV
25071-8185
US

V. Phone/Fax

Practice location:
  • Phone: 304-965-7979
  • Fax: 304-965-3239
Mailing address:
  • Phone: 304-965-7979
  • Fax: 304-965-3239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberRC00060126
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVB00066006
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: