Provider Demographics
NPI:1790446136
Name:POOLE, LEAH
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:POOLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 LASSITER MILL RD UNIT 305
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-5687
Mailing Address - Country:US
Mailing Address - Phone:252-202-3739
Mailing Address - Fax:
Practice Address - Street 1:3301 ATLANTIC AVE STE 109
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1658
Practice Address - Country:US
Practice Address - Phone:919-348-9245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-07
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0183031041C0700X
NCP0171561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical