Provider Demographics
NPI:1518705086
Name:L.E.A.D CHRISTIAN COUNSELING
Entity type:Organization
Organization Name:L.E.A.D CHRISTIAN COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:LAREE
Authorized Official - Last Name:NICKELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:708-831-2042
Mailing Address - Street 1:8730 HATHAWAY RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-6925
Mailing Address - Country:US
Mailing Address - Phone:708-831-2042
Mailing Address - Fax:
Practice Address - Street 1:8730 HATHAWAY RD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-6925
Practice Address - Country:US
Practice Address - Phone:708-831-2042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health