Provider Demographics
NPI:1194445247
Name:CARTNER, LEA
Entity type:Individual
Prefix:
First Name:LEA
Middle Name:
Last Name:CARTNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4879 COLLEGE ACRES DR APT A
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-7426
Mailing Address - Country:US
Mailing Address - Phone:704-773-1298
Mailing Address - Fax:
Practice Address - Street 1:5101 DUNLEA CT STE 201C
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-4436
Practice Address - Country:US
Practice Address - Phone:910-390-6626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCBACB816239106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician