Provider Demographics
NPI:1982712808
Name:MODIE, LEPOSAVA LEPA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LEPOSAVA
Middle Name:LEPA
Last Name:MODIE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:LEPOSAVA
Other - Middle Name:LEPA
Other - Last Name:MODIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:10720 CARMEL COMMONS BLVD STE 320A
Mailing Address - Street 2:LEPA MODIE LCSW, PLLC
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-3955
Mailing Address - Country:US
Mailing Address - Phone:704-733-7040
Mailing Address - Fax:704-552-9588
Practice Address - Street 1:10720 CARMEL COMMONS BLVD STE 320A
Practice Address - Street 2:LEPA MODIE LCSW, PLLC
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3955
Practice Address - Country:US
Practice Address - Phone:704-733-7040
Practice Address - Fax:704-552-9588
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0047931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003742Medicaid