Healthcare Provider Details

I. General information

NPI: 1174200067
Provider Name (Legal Business Name): SARA NOEMI LEIVA LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 UNION ST S STE 200
CONCORD NC
28025-5098
US

IV. Provider business mailing address

11 UNION ST S STE 200
CONCORD NC
28025-5098
US

V. Phone/Fax

Practice location:
  • Phone: 704-918-9741
  • Fax: 704-270-6213
Mailing address:
  • Phone: 704-918-9741
  • Fax: 704-270-6213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP019079
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: