Healthcare Provider Details

I. General information

NPI: 1124088596
Provider Name (Legal Business Name): LESLIE JEAN UTTERBACK MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 TUNNEL RD
ASHEVILLE NC
28805-2043
US

IV. Provider business mailing address

40 TALMADGE CT
ASHEVILLE NC
28806-2919
US

V. Phone/Fax

Practice location:
  • Phone: 828-299-2519
  • Fax: 828-299-5992
Mailing address:
  • Phone: 828-206-0717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC005427
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: