Provider Demographics
NPI:1497478374
Name:GAGNON, LEIGH MARIA (LCSWA)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:MARIA
Last Name:GAGNON
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 GLENACRE CT
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-8660
Mailing Address - Country:US
Mailing Address - Phone:336-420-3293
Mailing Address - Fax:
Practice Address - Street 1:211 S CENTENNIAL ST
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27260-5215
Practice Address - Country:US
Practice Address - Phone:336-899-1505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0170541041C0700X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical