Provider Demographics
NPI:1073083382
Name:THOMPSON-FORTE, LEEANNE (LCSW-A)
Entity Type:Individual
Prefix:
First Name:LEEANNE
Middle Name:
Last Name:THOMPSON-FORTE
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 UMSTEAD ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-2959
Mailing Address - Country:US
Mailing Address - Phone:803-431-1132
Mailing Address - Fax:
Practice Address - Street 1:5700 EXECUTIVE CENTER DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-8858
Practice Address - Country:US
Practice Address - Phone:803-431-1132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-29
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0123461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical