MEDICARE: LEONA KIMBERLY DAMICO LCMHC

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	101YM0800X	Mental Health Counselor	A12272	NC

General Provider Information

NPI Number	:	1679005805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONA KIMBERLY DAMICO LCMHC

Provider Business Mailing Address
First Line	:	125 EDINBURGH SOUTH DR STE 105
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27511-6484
Country	:	US
Telephone Number	:	919-234-6902
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 EDINBURGH SOUTH DR
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27511-6484
Country	:	US
Telephone Number	:	919-552-3111
Fax Number	:

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

Provider Enumeration Date	:	03/28/2017
Last Update Date	:	10/13/2020

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