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General NPI Number Information
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NPI Number | 1619577210
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Entity Type | Individual
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Provider Name | LEAH KATHRYN EDMONSON LCDC III
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Gender | Female
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Dates
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Enumeration Date | 11/01/2020
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 3430 S DIXIE DR STE 308
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City | MORAINE
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State | OH
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Zip | 45439-2316
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Country | US
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Telephone | 937-247-4717
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Fax |
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Provider Business Mailing Address
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Address Line | 3430 S DIXIE DR STE 308
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City | MORAINE
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State | OH
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Zip | 45439-2316
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Country | US
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Telephone | 937-247-4717
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 177356
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCDCIII.162822
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 174191
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 161862
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License Number State | OH
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