MEDICARE: DR. LEON HARLIE STURDIVANT SR. ED.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	323P00000X	Psychiatric Residential Treatment Facility	MHL041732	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215106984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEON HARLIE STURDIVANT SR. ED.D.

Provider Business Mailing Address
First Line	:	2501 DONLORA DR
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-6015
Country	:	US
Telephone Number	:	336-854-1718
Fax Number	:	336-854-1718

Provider Business Practice Location Address
First Line	:	808 MYSTIC DR
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27406-5726
Country	:	US
Telephone Number	:	336-854-1718
Fax Number	:	336-854-1718

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2008
Last Update Date	:	04/26/2026

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