Provider Demographics
NPI:1194849737
Name:LEIGH, JENNIFER COLLEEN (LPC, LCAS)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:COLLEEN
Last Name:LEIGH
Suffix:
Gender:F
Credentials:LPC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 OLDE POINT RD
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-2387
Mailing Address - Country:US
Mailing Address - Phone:910-232-4506
Mailing Address - Fax:
Practice Address - Street 1:7741 MARKET ST STE A
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-9444
Practice Address - Country:US
Practice Address - Phone:910-232-4506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC985101YA0400X
NC4197101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102221Medicaid