Healthcare Provider Details

I. General information

NPI: 1164864757
Provider Name (Legal Business Name): LESLIE SESSLEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2013
Last Update Date: 05/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2784 N DECATUR RD STE 145
DECATUR GA
30033-5903
US

IV. Provider business mailing address

2784 N DECATUR RD STE 145
DECATUR GA
30033-5903
US

V. Phone/Fax

Practice location:
  • Phone: 404-850-1570
  • Fax: 706-425-8600
Mailing address:
  • Phone: 404-850-1570
  • Fax: 706-425-8600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW004842
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: