Provider Demographics
NPI:1992078034
Name:LEAMING, WINDHAM JENNETTE (CFTS)
Entity type:Individual
Prefix:
First Name:WINDHAM
Middle Name:JENNETTE
Last Name:LEAMING
Suffix:
Gender:F
Credentials:CFTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12734
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28561-2734
Mailing Address - Country:US
Mailing Address - Phone:252-633-2244
Mailing Address - Fax:252-633-4156
Practice Address - Street 1:301 N GLENBURNIE RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-2706
Practice Address - Country:US
Practice Address - Phone:252-633-2244
Practice Address - Fax:252-633-4156
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCFTS1379174400000X
NCCFO04052174400000X
DECFTS1379174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795533Medicaid