Healthcare Provider Details

I. General information

NPI: 1285120717
Provider Name (Legal Business Name): LESLIE DEMPSEY LCMHC, LCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 12/12/2021
Certification Date: 12/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1348 WESTGATE CENTER DR
WINSTON SALEM NC
27103-2984
US

IV. Provider business mailing address

114 IDA ACRES
ELIZABETH CITY NC
27909-8744
US

V. Phone/Fax

Practice location:
  • Phone: 336-290-5005
  • Fax:
Mailing address:
  • Phone: 252-775-1908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number24381
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA14110
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA14110
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: