Provider Demographics
NPI:1558971465
Name:DUNN, LEAH DANIELLE
Entity Type:Individual
Prefix:MISS
First Name:LEAH
Middle Name:DANIELLE
Last Name:DUNN
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 1:149 BROOKWOOD AVE NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-4402
Mailing Address - Country:US
Mailing Address - Phone:828-460-6180
Mailing Address - Fax:
Practice Address - Street 1:8307 UNIVERSITY EXEC PARK DR STE 231
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-1381
Practice Address - Country:US
Practice Address - Phone:704-894-9678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician