Provider Demographics
NPI:1790801751
Name:FERNANDEZ, LEIGH ANN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:ANN
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:LPC
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 2192
Mailing Address - Street 2:
Mailing Address - City:WENDELL
Mailing Address - State:NC
Mailing Address - Zip Code:27591-2192
Mailing Address - Country:US
Mailing Address - Phone:919-332-1819
Mailing Address - Fax:919-341-8495
Practice Address - Street 1:106 NORTH FIRST AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545
Practice Address - Country:US
Practice Address - Phone:919-332-1819
Practice Address - Fax:919-341-8495
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4415101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102660Medicaid
NC141RNOtherBCBS PROVIDER NUMBER