Individual
JACQUELINE MONIQUE PARKS LEACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
419 S YORK ST, GASTONIA, NC 28052-4035
(704) 865-8722
Mailing address
314 DAVIS RD # 2, SHELBY, NC 28152-8737
(704) 418-1632
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
A14757
NC
Other
Enumeration date
04/12/2019
Last updated
09/30/2019
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