Provider Demographics
NPI:1861450207
Name:LEEDS, DEBRA K (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:K
Last Name:LEEDS
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 1:154 MINE LAKE CT STE 200
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6417
Mailing Address - Country:US
Mailing Address - Phone:919-389-9952
Mailing Address - Fax:
Practice Address - Street 1:154 MINE LAKE CT STE 200
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6417
Practice Address - Country:US
Practice Address - Phone:919-389-9952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0050971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical