Healthcare Provider Details

I. General information

NPI: 1639577067
Provider Name (Legal Business Name): LESLIE WORLEY LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2014
Last Update Date: 04/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 TIVOLI LAKE CT
SILVER SPRING MD
20906-5904
US

IV. Provider business mailing address

5344 LIGHTNING VIEW RD
COLUMBIA MD
21045-2241
US

V. Phone/Fax

Practice location:
  • Phone: 202-810-3309
  • Fax:
Mailing address:
  • Phone: 131-751-4113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18778
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: