| Doctor Name: | LEILA FAZELI |
| NPI Number: | 1114383395 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | LGP6760 |
| Business Practice Address: | 9475 Deereco Rd Suite 410 Core Counseling Lutherville Timonium, MD - 210932118 |
| Business Phone Number: | 3013059174 |
| Business Fax Number: | |
| Mailing Address: | 76 Cranbrook Rd Unit 291, COCKEYSVILLE |
| State: | MD |
| Postal Code: | 210303404 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 01/04/2016 |
| NPI Last Update Date: | 01/04/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | LGP6760 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |