Provider Demographics
NPI:1104059443
Name:BERRY, LEAH (LCMHCS, LCAS, CEDS-S)
Entity type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:LCMHCS, LCAS, CEDS-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8212 CREEDMOOR RD STE 101
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-1386
Mailing Address - Country:US
Mailing Address - Phone:919-883-4478
Mailing Address - Fax:
Practice Address - Street 1:8212 CREEDMOOR RD STE 101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-1386
Practice Address - Country:US
Practice Address - Phone:919-883-4478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-03
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1396101YA0400X
NC7485101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional