1205668449 NPI number — JACQUELINE HELMS LEAHY LCSWA

Table of content: JACQUELINE HELMS LEAHY LCSWA (NPI 1205668449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205668449 NPI number — JACQUELINE HELMS LEAHY LCSWA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEAHY
Provider First Name:
JACQUELINE
Provider Middle Name:
HELMS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSWA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WOOTEN
Provider Other First Name:
JACQUELINE
Provider Other Middle Name:
DARLENE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1205668449
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1826 RIVERSIDE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LENOIR
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28645-6595
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-774-6013
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2415 MORGANTON BLVD SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LENOIR
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28645-9691
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-774-6013
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/16/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)