Healthcare Provider Details

I. General information

NPI: 1235557539
Provider Name (Legal Business Name): MICHELLE LESHER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 04/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 MAIN AVE
PASSAIC NJ
07055-5452
US

IV. Provider business mailing address

22 LEITCH PL
PASSAIC NJ
07055-4411
US

V. Phone/Fax

Practice location:
  • Phone: 862-686-3186
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00163000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number44SC05505200
License Number StateNJ

VIII. Authorized Official

Name: MRS. MICHELLE LESHER
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 862-686-3186