1427464361 NPI number — CHRISTOPHER JASON LEACH MS NCC LPC

Table of content: CHRISTOPHER JASON LEACH MS NCC LPC (NPI 1427464361)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427464361 NPI number — CHRISTOPHER JASON LEACH MS NCC LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEACH
Provider First Name:
CHRISTOPHER
Provider Middle Name:
JASON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS NCC LPC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427464361
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
805 RYMARK CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27513-2634
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-819-6082
Provider Business Mailing Address Fax Number:
919-573-0438

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7330 CHAPEL HILL RD
Provider Second Line Business Practice Location Address:
STE 206
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27607-5042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-819-6082
Provider Business Practice Location Address Fax Number:
919-573-0438
Provider Enumeration Date:
07/10/2014

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: 101YM0800X , with the licence number:  9420 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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