Healthcare Provider Details

I. General information

NPI: 1194849737
Provider Name (Legal Business Name): JENNIFER COLLEEN LEIGH LPC, LCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 SHUCKIN ST UNIT 201
HAMPSTEAD NC
28443-8728
US

IV. Provider business mailing address

139 OLDE POINT RD
HAMPSTEAD NC
28443-2387
US

V. Phone/Fax

Practice location:
  • Phone: 910-232-4506
  • Fax: 910-795-0689
Mailing address:
  • Phone: 910-232-4506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4197
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number985
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: