MEDICARE: JOHNNY D LEONARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	2305	NC
2	101YP2500X	Professional Counselor	9092	NC
3	101YM0800X	Mental Health Counselor	9092	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407132079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHNNY D LEONARD

Provider Business Mailing Address
First Line	:	225 FAIRWAY DR APT A
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28305-5564
Country	:	US
Telephone Number	:	910-489-0429
Fax Number	:	910-229-3622

Provider Business Practice Location Address
First Line	:	901 ARSENAL AVE
Second Line	:	SUITE 202
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28305-5398
Country	:	US
Telephone Number	:	910-323-3368
Fax Number	:	910-486-7000

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2011
Last Update Date	:	07/31/2025

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Directions to “ JOHNNY D LEONARD ” Practice Location

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