Provider Demographics
NPI:1538244793
Name:WITENBARGER, LEAH SHEA (LPC, NCC)
Entity type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:SHEA
Last Name:WITENBARGER
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 MOSS PINK DR
Mailing Address - Street 2:
Mailing Address - City:VASS
Mailing Address - State:NC
Mailing Address - Zip Code:28394-8412
Mailing Address - Country:US
Mailing Address - Phone:910-690-8183
Mailing Address - Fax:910-491-9631
Practice Address - Street 1:305 N PAGE ROAD
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374
Practice Address - Country:US
Practice Address - Phone:910-690-8183
Practice Address - Fax:910-491-9631
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5364101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103281Medicaid