Healthcare Provider Details

I. General information

NPI: 1861450207
Provider Name (Legal Business Name): DEBRA K LEEDS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 01/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 MINE LAKE CT STE 200
RALEIGH NC
27615-6417
US

IV. Provider business mailing address

154 MINE LAKE CT STE 200
RALEIGH NC
27615-6417
US

V. Phone/Fax

Practice location:
  • Phone: 919-389-9952
  • Fax:
Mailing address:
  • Phone: 919-389-9952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC005097
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: