Healthcare Provider Details

I. General information

NPI: 1871191262
Provider Name (Legal Business Name): LESLIE N WEAVER LPC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2020
Last Update Date: 10/16/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

656 TOWNSEND CIRCLE CHICKASAW
ALABAMA AL
36611
US

IV. Provider business mailing address

656 TOWNSEND CIRCLE CHICKASAW
ALABAMA AL
36611
US

V. Phone/Fax

Practice location:
  • Phone: 251-751-7076
  • Fax:
Mailing address:
  • Phone: 251-751-7076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2991
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: