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NPI Code Detail

MEDICARE: A NEW LEAF THERAPEUTIC SERVICES, PLLC

MEDICARE: A NEW LEAF THERAPEUTIC SERVICES, PLLC
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
1106H00000XMarriage & Family Therapist
2103K00000XBehavior Analyst
3101YM0800XMental Health Counselor
4101YP2500XProfessional Counselor
51041C0700XClinical Social Worker

General Provider Information

NPI Number : 1710391867
Entity Type Code : Organization
Provider Name (Legal Business Name) : A NEW LEAF THERAPEUTIC SERVICES, PLLC
Provider Business Mailing Address
First Line : 920 CAMBRIDGE ST
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28303-5300
Country : US
Telephone Number : 910-849-3355
Fax Number :
Provider Business Practice Location Address
First Line : 920 CAMBRIDGE ST
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28303-5300
Country : US
Telephone Number : 910-849-3355
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MS. JUDITH J. HILL
Credential : MSW, LCSW
Telephone Number : 910-493-3555
Provider Enumeration Date : 06/17/2014
Last Update Date : 02/01/2017

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