Provider Demographics
NPI:1790466373
Name:WYRICK, LEIGH ANN (LCMHCA)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:ANN
Last Name:WYRICK
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 N ELM ST APT J5
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-6615
Mailing Address - Country:US
Mailing Address - Phone:252-288-7890
Mailing Address - Fax:
Practice Address - Street 1:10706 SIKES PL STE 275
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-8015
Practice Address - Country:US
Practice Address - Phone:704-577-4071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18827101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health