Provider Demographics
NPI:1609600519
Name:LEAKE, TANYA SHENEE (NBC-HWC)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:SHENEE
Last Name:LEAKE
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4094 HILL HOUSE RD SW
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-3547
Mailing Address - Country:US
Mailing Address - Phone:415-516-6297
Mailing Address - Fax:
Practice Address - Street 1:4094 HILL HOUSE RD SW
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-3547
Practice Address - Country:US
Practice Address - Phone:415-516-6297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach