MEDICARE: MRS. LESLIE HOLLEY LCPC, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	PRC14906	DC
2	101YP2500X	Professional Counselor	178.008404	IL
3	101YP2500X	Professional Counselor	0701007056	VA
4	101YP2500X	Professional Counselor	2016034637	MO
5	101YP2500X	Professional Counselor	LC8173	MD

General Provider Information

NPI Number	:	1699027607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LESLIE HOLLEY LCPC, LPC

Provider Business Mailing Address
First Line	:	8730 GEORGIA AVE STE 200D
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-3604
Country	:	US
Telephone Number	:	312-624-8610
Fax Number	:

Provider Business Practice Location Address
First Line	:	8730 GEORGIA AVE STE 200D
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-3604
Country	:	US
Telephone Number	:	312-775-2316
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2012
Last Update Date	:	01/05/2019

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