Provider Demographics
NPI:1952756959
Name:SALLEY, LEANDRA (MSW, LCAS, LCSW-A)
Entity Type:Individual
Prefix:
First Name:LEANDRA
Middle Name:
Last Name:SALLEY
Suffix:
Gender:F
Credentials:MSW, LCAS, LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 INSTITUTE ST UNIT 493
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-4919
Mailing Address - Country:US
Mailing Address - Phone:980-234-9847
Mailing Address - Fax:
Practice Address - Street 1:421 PARKER AVE STE A
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-3418
Practice Address - Country:US
Practice Address - Phone:980-234-9847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-27
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22452101YA0400X
NCP0155861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty