Provider Demographics
NPI:1871259762
Name:MADAMBA, LEAH SUBALUSKY (MS, NCC, LCMHC)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:SUBALUSKY
Last Name:MADAMBA
Suffix:
Gender:F
Credentials:MS, NCC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 BEVERLY RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805-2436
Mailing Address - Country:US
Mailing Address - Phone:828-243-0910
Mailing Address - Fax:
Practice Address - Street 1:500 WINDING GAP RD
Practice Address - Street 2:
Practice Address - City:LAKE TOXAWAY
Practice Address - State:NC
Practice Address - Zip Code:28747-8786
Practice Address - Country:US
Practice Address - Phone:828-885-5920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4354101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health