Provider Demographics
NPI:1598162992
Name:LEACH, TIMEA
Entity Type:Individual
Prefix:
First Name:TIMEA
Middle Name:
Last Name:LEACH
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 1:7330 CHAPEL HILL RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-0177
Mailing Address - Country:US
Mailing Address - Phone:609-649-3943
Mailing Address - Fax:
Practice Address - Street 1:7330 CHAPEL HILL RD
Practice Address - Street 2:SUITE 206
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-0177
Practice Address - Country:US
Practice Address - Phone:609-649-3943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-01
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10858101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health