Provider Demographics
NPI:1376697425
Name:LEACH, AMY M (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:LEACH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:308 FLEMING DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-3224
Mailing Address - Country:US
Mailing Address - Phone:919-328-0010
Mailing Address - Fax:
Practice Address - Street 1:CAMPUS HEALTH SERVICES
Practice Address - Street 2:CAMPUS BOX 7470
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7470
Practice Address - Country:US
Practice Address - Phone:919-966-3658
Practice Address - Fax:919-966-4605
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NCC0063661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6007721Medicaid