Provider Demographics
NPI:1992009211
Name:LEIDER, SHERI DOUGLAS (LCSW)
Entity Type:Individual
Prefix:
First Name:SHERI
Middle Name:DOUGLAS
Last Name:LEIDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHERI
Other - Middle Name:DOUGLAS
Other - Last Name:ROLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:6810 DALTREY CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-3820
Mailing Address - Country:US
Mailing Address - Phone:919-609-2566
Mailing Address - Fax:
Practice Address - Street 1:6810 DALTREY CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-3820
Practice Address - Country:US
Practice Address - Phone:919-609-2566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-29
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026981101YM0800X
NCC0076901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6009051Medicaid