Provider Demographics
NPI:1174087258
Name:RILEY, LEAH (MED, LPC)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:RODERICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, LPC
Mailing Address - Street 1:1900 14TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-4906
Mailing Address - Country:US
Mailing Address - Phone:205-933-0338
Mailing Address - Fax:
Practice Address - Street 1:1900 14TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-4906
Practice Address - Country:US
Practice Address - Phone:205-933-0338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC2697A101YM0800X
AL4090101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health