Healthcare Provider Details

I. General information

NPI: 1215841630
Provider Name (Legal Business Name): LEONARD CORONADO LCMHCA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 CASCADE POINTE LN STE 101
CARY NC
27513-5824
US

IV. Provider business mailing address

5331 WAYNE ST APT A
RALEIGH NC
27606-8136
US

V. Phone/Fax

Practice location:
  • Phone: 574-216-1694
  • Fax: 574-635-5999
Mailing address:
  • Phone: 574-216-1694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberA23403
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: