Healthcare Provider Details

I. General information

NPI: 1750583167
Provider Name (Legal Business Name): LESLIE CRANDALL HUNTER LICSW, LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 13TH ST NE
WASHINGTON DC
20017-2611
US

IV. Provider business mailing address

4025 13TH ST NE
WASHINGTON DC
20017-2611
US

V. Phone/Fax

Practice location:
  • Phone: 202-841-8829
  • Fax: 202-387-3049
Mailing address:
  • Phone: 202-841-8829
  • Fax: 202-387-3049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15770
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904010968
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50080512
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: