Individual
CHIANTI LEAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSWA
Contact information
Practice address
100 BILLINGSLEY RD, CHARLOTTE, NC 28211-1002
(704) 376-7447
(704) 376-2172
Mailing address
5820 E W T HARRIS BLVD STE 205, CHARLOTTE, NC 28215-4032
(704) 469-1243
(704) 469-1713
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
28735
NC
1041C0700X
Clinical Social Worker
Primary
P016290
NC
Other
Enumeration date
06/16/2021
Last updated
09/28/2023
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