Provider Demographics
NPI:1861420317
Name:MARTIN, RICHARD LEEDS (LCSW)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:LEEDS
Last Name:MARTIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5405 AUBREY CT
Mailing Address - Street 2:
Mailing Address - City:PFAFFTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27040-9384
Mailing Address - Country:US
Mailing Address - Phone:336-765-3032
Mailing Address - Fax:336-760-6977
Practice Address - Street 1:1396 OLD MILL CIRCLE
Practice Address - Street 2:SOTILE PSYCHOLOGICAL ASSOCIATES, PLLC
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103
Practice Address - Country:US
Practice Address - Phone:336-765-3032
Practice Address - Fax:336-760-6977
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLPC748101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor