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General NPI Number Information
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NPI Number | 1205716909
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Entity Type | Organization
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Legal Business Name | THE LEON&ALINE HOUSE
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Dates
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Enumeration Date | 09/03/2025
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 706 E SOUTHERN AVE APT 319 APT 319
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City | PHOENIX
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State | AZ
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Zip | 85040-0105
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Country | US
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Telephone | 480-203-9107
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Fax | 480-203-9107
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Provider Business Mailing Address
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Address Line | 706 E SOUTHERN AVE APT 319
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City | PHOENIX
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State | AZ
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Zip | 85040-0105
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Country | US
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Telephone | 480-203-9107
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Fax | 480-203-9107
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Authorized Official
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Title or Position | OWNER
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Name | MS. WANDA JOYCE HINES
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Credential |
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Telephone | 480-203-9107
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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