Provider Demographics
NPI:1326526732
Name:FLEIG, ANNA KATHLEEN
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:KATHLEEN
Last Name:FLEIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5015 WINSTER DR APT 101
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-2966
Mailing Address - Country:US
Mailing Address - Phone:704-351-7692
Mailing Address - Fax:
Practice Address - Street 1:983 MAR DON DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-4624
Practice Address - Country:US
Practice Address - Phone:336-923-7426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14114101YM0800X
NC14114101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC14114OtherNORTH CAROLINA BOARD OF LICENSED CLINICAL MENTAL HEALTH COUNSELORS
NCA14114OtherNORTH CAROLINA BOARD OF LICENSED PROFESSIONAL COUNSELORS