Healthcare Provider Details

I. General information

NPI: 1538075825
Provider Name (Legal Business Name): SIMONE LEAVELL BRUCE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 STREAM DALE CIR NW
CONCORD NC
28027-0272
US

IV. Provider business mailing address

350 GEORGE W LILES PKWY NW STE 160
CONCORD NC
28027-2411
US

V. Phone/Fax

Practice location:
  • Phone: 502-417-0789
  • Fax: 502-417-0789
Mailing address:
  • Phone: 502-417-0789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. SIMONE LEAVELL LEAVELL
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSYD
Phone: 502-417-0789