Provider Demographics
NPI:1679005805
Name:DAMICO, LEONA KIMBERLY (LCMHC)
Entity type:Individual
Prefix:
First Name:LEONA
Middle Name:KIMBERLY
Last Name:DAMICO
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 EDINBURGH SOUTH DR STE 105
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-6484
Mailing Address - Country:US
Mailing Address - Phone:919-234-6902
Mailing Address - Fax:
Practice Address - Street 1:125 EDINBURGH SOUTH DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6484
Practice Address - Country:US
Practice Address - Phone:919-552-3111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-28
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12272101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health