| Doctor Name: | DR. ANDREA MARIE LEITHEISER |
| NPI Number: | 1477964567 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, PHD |
| License Number: | 001257 |
| Business Practice Address: | 674 Harmon Loop Rd Ste 214 Dededo, GU - 969296535 |
| Business Phone Number: | 6714877747 |
| Business Fax Number: | |
| Mailing Address: | Po Box 217922, BARRIGADA |
| State: | GU |
| Postal Code: | 969216957 |
| Phone Number: | 6716887712 |
| Fax Number: | 6716375550 |
| NPI Enumeration Date: | 05/12/2014 |
| NPI Last Update Date: | 05/12/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TB0200X |
| License Number: | 001257 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | AL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Cognitive & Behavioral |
| Taxonomy Definition: | |