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General NPI Number Information
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NPI Number | 1760784607
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Entity Type | Individual
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Provider Name | CASSANDRA E LIPKA LEITE LMHC
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Gender | Female
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Dates
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Enumeration Date | 11/29/2010
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Last Update Date | 06/11/2013
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Provider Practice Location Address
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Address Line | 619 S MARION AVE
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City | LAKE CITY
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State | FL
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Zip | 32025-5808
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Country | US
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Telephone | 386-755-5301
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Fax |
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Provider Business Mailing Address
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Address Line | 1726 KINGSLEY AVE STE 2
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City | ORANGE PARK
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State | FL
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Zip | 32073-4411
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Country | US
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Telephone | 904-278-5644
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Fax | 904-278-5659
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH 10481
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License Number State | FL
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