Provider Demographics
NPI:1710643135
Name:PETTRESS, LEATHA MAE LEE (LCSW-A)
Entity Type:Individual
Prefix:
First Name:LEATHA
Middle Name:MAE LEE
Last Name:PETTRESS
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5205 DANA DR APT H
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-2347
Mailing Address - Country:US
Mailing Address - Phone:919-449-1780
Mailing Address - Fax:
Practice Address - Street 1:249 E NC HIGHWAY 54 STE 320
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-2490
Practice Address - Country:US
Practice Address - Phone:919-907-3334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical