Provider Demographics
NPI:1588187116
Name:CALVIN, LEANNA MARIE (LCSWA)
Entity Type:Individual
Prefix:
First Name:LEANNA
Middle Name:MARIE
Last Name:CALVIN
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 1:1705 FLAT RIVER DR APT 103
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-5336
Mailing Address - Country:US
Mailing Address - Phone:707-704-7769
Mailing Address - Fax:
Practice Address - Street 1:1705 FLAT RIVER DR APT 103
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-5336
Practice Address - Country:US
Practice Address - Phone:707-704-7769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP011841104100000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC000046515531Medicaid