Healthcare Provider Details

I. General information

NPI: 1508778184
Provider Name (Legal Business Name): LEONARDO LOPEZ LCSW-A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3012 FALSTAFF RD
RALEIGH NC
27610-1813
US

IV. Provider business mailing address

2670 DURHAM CHAPEL HILL BLVD
DURHAM NC
27707-2829
US

V. Phone/Fax

Practice location:
  • Phone: 919-615-1027
  • Fax:
Mailing address:
  • Phone: 919-251-9001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP024451
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: