Provider Demographics
NPI:1699218396
Name:CANTRELL, LEANNE JOHNSON (RDN)
Entity Type:Individual
Prefix:MRS
First Name:LEANNE
Middle Name:JOHNSON
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 604050
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-4050
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6329 UNITY ST
Practice Address - Street 2:STE
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-7186
Practice Address - Country:US
Practice Address - Phone:336-793-2518
Practice Address - Fax:336-793-9589
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005011133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered