Provider Demographics
NPI:1790385326
Name:MULLIGAN, LEILONI (LCSW)
Entity Type:Individual
Prefix:
First Name:LEILONI
Middle Name:
Last Name:MULLIGAN
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 1:3000 BETHESDA PL STE 104
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3323
Mailing Address - Country:US
Mailing Address - Phone:704-231-8180
Mailing Address - Fax:949-577-4324
Practice Address - Street 1:3000 BETHESDA PL STE 202
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3324
Practice Address - Country:US
Practice Address - Phone:336-293-4107
Practice Address - Fax:949-577-4324
Is Sole Proprietor?:No
Enumeration Date:2020-11-01
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0142391041C0700X
NCC0149471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical