Healthcare Provider Details

I. General information

NPI: 1104778935
Provider Name (Legal Business Name): MR. JOSEPH CAMERON LEGGETT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2026
Last Update Date: 02/12/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 JASPER ST
CLINTON NC
28328-2340
US

IV. Provider business mailing address

1002 JASPER ST
CLINTON NC
28328-2340
US

V. Phone/Fax

Practice location:
  • Phone: 910-305-9810
  • Fax: 910-305-9810
Mailing address:
  • Phone: 910-305-9810
  • Fax: 910-305-9810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA22534
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: