Provider Demographics
NPI:1679807671
Name:LEICHT, ANNIE M
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:M
Last Name:LEICHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:771 W BLAINE ST STE D
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-3940
Mailing Address - Country:US
Mailing Address - Phone:951-441-5542
Mailing Address - Fax:
Practice Address - Street 1:623 N MAIN ST
Practice Address - Street 2:SUITE D-11
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92880-1407
Practice Address - Country:US
Practice Address - Phone:951-737-2962
Practice Address - Fax:951-737-2783
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)