Provider Demographics
NPI:1215760269
Name:LEARY, LAKEISHA TIANA
Entity type:Individual
Prefix:
First Name:LAKEISHA
Middle Name:TIANA
Last Name:LEARY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 HARDWICK ST
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-6738
Mailing Address - Country:US
Mailing Address - Phone:984-212-1699
Mailing Address - Fax:
Practice Address - Street 1:71 KILMAYNE DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-5568
Practice Address - Country:US
Practice Address - Phone:336-327-1708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-24
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA20278101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health