Provider Demographics
NPI:1659991826
Name:GOODES, LEANNA PAI (LCMHC)
Entity Type:Individual
Prefix:
First Name:LEANNA
Middle Name:PAI
Last Name:GOODES
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:LEANNA
Other - Middle Name:
Other - Last Name:PAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 13289
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27709-3289
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1900 SCOTT AVE STE 101
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-6046
Practice Address - Country:US
Practice Address - Phone:704-680-3140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-17
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15266101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor