Provider Demographics
NPI:1699363598
Name:LEONARD, VICTORIA (LCSW)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:LEONARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6752 GORDON RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-8464
Mailing Address - Country:US
Mailing Address - Phone:910-463-2442
Mailing Address - Fax:910-661-3671
Practice Address - Street 1:6752 GORDON RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-8464
Practice Address - Country:US
Practice Address - Phone:910-463-2442
Practice Address - Fax:910-661-3671
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0147291041C0700X
NCC0154211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical