Provider Demographics
NPI:1073781019
Name:DEPEAL, LESA MARIE (LISW-CP)
Entity Type:Individual
Prefix:MRS
First Name:LESA
Middle Name:MARIE
Last Name:DEPEAL
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:LESA
Other - Middle Name:MARIE
Other - Last Name:MOFFETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW, CTRS
Mailing Address - Street 1:508 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3875
Mailing Address - Country:US
Mailing Address - Phone:919-286-0411
Mailing Address - Fax:919-416-5983
Practice Address - Street 1:508 FULTON ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3875
Practice Address - Country:US
Practice Address - Phone:919-286-0411
Practice Address - Fax:919-416-5983
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8929104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker