Provider Demographics
NPI:1457698185
Name:NESBITT, COURTNEY LEAK (LCSW)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LEAK
Last Name:NESBITT
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 1:6904 MURRAY GREY LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-3395
Mailing Address - Country:US
Mailing Address - Phone:803-493-9298
Mailing Address - Fax:866-384-4733
Practice Address - Street 1:3717 LATROBE DR STE 750
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-4826
Practice Address - Country:US
Practice Address - Phone:803-493-9298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC106621041C0700X
NCC0082851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ457530281Medicare PIN