| Doctor Name: | MRS. LEAH VENUS GADDIS |
| NPI Number: | 1053743690 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S. |
| License Number: | 1508 |
| Business Practice Address: | 2012 Highway 90 Ste 34 Gautier, MS - 395535305 |
| Business Phone Number: | 2288092281 |
| Business Fax Number: | 2288095546 |
| Mailing Address: | 2012 Highway 90 Ste 34, GAUTIER |
| State: | MS |
| Postal Code: | 395535305 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 08/06/2013 |
| NPI Last Update Date: | 08/06/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 1508 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |