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General NPI Number Information
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NPI Number | 1982496980
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Entity Type | Individual
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Provider Name | MICHAEL AARON LEAK
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Gender | Male
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Dates
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Enumeration Date | 05/19/2025
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 1010 HADDONFIELD BERLIN RD STE 403
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City | VOORHEES
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State | NJ
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Zip | 08043-3514
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Country | US
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Telephone | 856-873-9069
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Fax |
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Provider Business Mailing Address
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Address Line | 6004 BINGHAM ST
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City | PHILADELPHIA
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State | PA
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Zip | 19111-5720
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Country | US
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Telephone | 215-870-0353
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | APC001258
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License Number State | PA
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