Provider Demographics
NPI:1437934593
Name:LEADER, CARA R (PLADC)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:R
Last Name:LEADER
Suffix:
Gender:F
Credentials:PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 VICKI LN STE 105
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-4542
Mailing Address - Country:US
Mailing Address - Phone:402-256-7883
Mailing Address - Fax:402-226-6024
Practice Address - Street 1:1909 VICKI LN STE 105
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4542
Practice Address - Country:US
Practice Address - Phone:402-256-7883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-2096101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor