Provider Demographics
NPI:1790925675
Name:LEATHERWOOD, STEVE J (MA, LPC, NBCC)
Entity Type:Individual
Prefix:MR
First Name:STEVE
Middle Name:J
Last Name:LEATHERWOOD
Suffix:
Gender:M
Credentials:MA, LPC, NBCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1235 FALLSTON RD
Mailing Address - Street 2:PO BOX 699
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3457
Mailing Address - Country:US
Mailing Address - Phone:704-481-1332
Mailing Address - Fax:704-481-1373
Practice Address - Street 1:1235 FALLSTON RD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3457
Practice Address - Country:US
Practice Address - Phone:704-481-1332
Practice Address - Fax:704-481-1373
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-04
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC448101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional