Provider Demographics
NPI:1417142217
Name:MCCALLUM, LEAH (PHD,, LPC, NCC)
Entity Type:Individual
Prefix:DR
First Name:LEAH
Middle Name:
Last Name:MCCALLUM
Suffix:
Gender:F
Credentials:PHD,, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 ROWLAND CEMETERY ROAD
Mailing Address - Street 2:
Mailing Address - City:ROWLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28383-6969
Mailing Address - Country:US
Mailing Address - Phone:910-422-8056
Mailing Address - Fax:910-422-8056
Practice Address - Street 1:1517 ROWLAND CEMETERY ROAD
Practice Address - Street 2:
Practice Address - City:ROWLAND
Practice Address - State:NC
Practice Address - Zip Code:28383-6969
Practice Address - Country:US
Practice Address - Phone:910-422-8056
Practice Address - Fax:910-422-8056
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7240101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104124Medicaid