Provider Demographics
NPI:1144059072
Name:FORD-THREATT, LESHAWNA (LPC)
Entity type:Individual
Prefix:
First Name:LESHAWNA
Middle Name:
Last Name:FORD-THREATT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2013 ANSLEY DR
Mailing Address - Street 2:
Mailing Address - City:MOODY
Mailing Address - State:AL
Mailing Address - Zip Code:35004-3279
Mailing Address - Country:US
Mailing Address - Phone:205-999-6001
Mailing Address - Fax:
Practice Address - Street 1:2500 4TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-2521
Practice Address - Country:US
Practice Address - Phone:205-941-1799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5326101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional