MEDICARE: LEILA CHAMPION CDCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1023810363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEILA CHAMPION CDCA

Provider Business Mailing Address
First Line	:	4764 FISHBURG RD STE E
Second Line	:
City	:	HUBER HEIGHTS
State	:	OH
Zip	:	45424-5456
Country	:	US
Telephone Number	:	317-531-7990
Fax Number	:

Provider Business Practice Location Address
First Line	:	4764 FISHBURG RD STE E
Second Line	:
City	:	HUBER HEIGHTS
State	:	OH
Zip	:	45424-5456
Country	:	US
Telephone Number	:	317-531-7990
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2025
Last Update Date	:	03/26/2025

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Directions to “ LEILA CHAMPION CDCA” Practice Location

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