Healthcare Provider Details

I. General information

NPI: 1730099052
Provider Name (Legal Business Name): TASHERA NICOLE LEONARD LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19902 N COVE RD
CORNELIUS NC
28031-6571
US

IV. Provider business mailing address

4810 STAFFORDSHIRE LN
CHARLOTTE NC
28213-4391
US

V. Phone/Fax

Practice location:
  • Phone: 704-624-7179
  • Fax:
Mailing address:
  • Phone: 252-258-0649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP024492
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: