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NPI Code Detail

MEDICARE: MS. LEIGH ANNE FAGIN LICSW

MEDICARE: MS. LEIGH ANNE FAGIN LICSW
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
11041C0700XClinical Social Worker4365CAL

General Provider Information

NPI Number : 1114568508
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LEIGH ANNE FAGIN LICSW
Provider Business Mailing Address
First Line : 7125 UNIVERSITY CT
Second Line :
City : MONTGOMERY
State : AL
Zip : 36117-8016
Country : US
Telephone Number : 334-239-2622
Fax Number :
Provider Business Practice Location Address
First Line : 7125 UNIVERSITY CT
Second Line :
City : MONTGOMERY
State : AL
Zip : 36117-8016
Country : US
Telephone Number : 334-239-2622
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2019
Last Update Date : 10/07/2019

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