Provider Demographics
NPI:1588874200
Name:WILSON, LEAH MARIE (LMFT)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:MARIE
Last Name:WILSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CAPITOLA DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-4496
Mailing Address - Country:US
Mailing Address - Phone:919-474-6385
Mailing Address - Fax:919-474-6401
Practice Address - Street 1:100 CAPITOLA DR
Practice Address - Street 2:SUITE 310
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-4496
Practice Address - Country:US
Practice Address - Phone:919-474-6385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
NC1376106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist