Healthcare Provider Details

I. General information

NPI: 1821927583
Provider Name (Legal Business Name): TIERRA S LEACH LCMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1057 DRESSER CT
RALEIGH NC
27609-7323
US

IV. Provider business mailing address

1057 DRESSER CT
RALEIGH NC
27609-7323
US

V. Phone/Fax

Practice location:
  • Phone: 910-474-4000
  • Fax:
Mailing address:
  • Phone: 984-212-0028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA18135
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: