MEDICARE: JESSICA LEISTIKOW LCMHC

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	101YM0800X	Mental Health Counselor	15748	NC

General Provider Information

NPI Number	:	1407471527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LEISTIKOW LCMHC

Provider Business Mailing Address
First Line	:	1931 NEW GARDEN RD STE 204
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-2558
Country	:	US
Telephone Number	:	919-391-0122
Fax Number	:	919-289-1758

Provider Business Practice Location Address
First Line	:	1931 NEW GARDEN RD STE 204
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-2558
Country	:	US
Telephone Number	:	919-391-0122
Fax Number	:	919-289-1758

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

Provider Enumeration Date	:	06/15/2020
Last Update Date	:	04/30/2025

Similar Medicare Providers

1881540235 — TONE AND GLOW MD MEDICAL AESTHETICS AND WEIGHT LOSS
Practice Location Address:

1931 NEW GARDEN RD STE 108
GREENSBORO, NC
27410-2558

Practice Phone: 336-579-8400
Practice Fax: 336-360-0246

1437751310 — MRS. PATRICIA DENISE BAGWELL LCMHC
Practice Location Address:

1931 NEW GARDEN RD STE 202
GREENSBORO, NC
27410-2558

Practice Phone: 336-339-1860
Practice Fax:

1215715461 — COLORS OF YOU COUNSELING AND CONSULTING PLLC
Practice Location Address:

1931 NEW GARDEN RD STE 204
GREENSBORO, NC
27410-2558

Practice Phone: 919-391-0122
Practice Fax: 919-289-1758

1598653263 — KAYDEN CLUBB COSTELLO
Practice Location Address:

1931 NEW GARDEN RD STE 210
GREENSBORO, NC
27410-2558

Practice Phone: 336-405-2601
Practice Fax:

1528942315 — BRANDY NICHOLE TRULOVE
Practice Location Address:

1931 NEW GARDEN RD STE 210
GREENSBORO, NC
27410-2558

Practice Phone: 336-405-2601
Practice Fax:

1518831742 — MADELYN SMITH
Practice Location Address:

1931 NEW GARDEN RD STE 210
GREENSBORO, NC
27410-2558

Practice Phone: 336-405-2601
Practice Fax:

Directions to “ JESSICA LEISTIKOW LCMHC” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.