Provider Demographics
NPI:1356880884
Name:LEATHERS, LOVIETTE
Entity type:Individual
Prefix:
First Name:LOVIETTE
Middle Name:
Last Name:LEATHERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LLOVIETTE
Other - Middle Name:
Other - Last Name:LEATHERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCAS-A
Mailing Address - Street 1:4712 BAY POINT DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-9415
Mailing Address - Country:US
Mailing Address - Phone:919-308-7269
Mailing Address - Fax:
Practice Address - Street 1:214 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-2404
Practice Address - Country:US
Practice Address - Phone:919-683-5300
Practice Address - Fax:919-683-5306
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-23449101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)