Healthcare Provider Details

I. General information

NPI: 1720771637
Provider Name (Legal Business Name): JOSHUA JAMES LEDERLE MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2023
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

539 KEISLER DR STE 204
CARY NC
27518-9320
US

IV. Provider business mailing address

190 GLENPARK PL
CARY NC
27511-4216
US

V. Phone/Fax

Practice location:
  • Phone: 910-325-2887
  • Fax:
Mailing address:
  • Phone: 847-284-4947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA22368
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: