Healthcare Provider Details

I. General information

NPI: 1649133323
Provider Name (Legal Business Name): LESLIE VISOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3817 HIDDEN VALLEY CIR
LAWRENCEVILLE GA
30044-6135
US

IV. Provider business mailing address

3817 HIDDEN VALLEY CIR
LAWRENCEVILLE GA
30044-6135
US

V. Phone/Fax

Practice location:
  • Phone: 731-293-7476
  • Fax:
Mailing address:
  • Phone: 731-293-7476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC007809
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: