Healthcare Provider Details

I. General information

NPI: 1710094289
Provider Name (Legal Business Name): LESLEY PAIGE DAVIS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LESLEY D IHNAT

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 S FRONT ST 5TH FLOOR
HARRISBURG PA
17104-1619
US

IV. Provider business mailing address

118 WASHINGTON ST
HARRISBURG PA
17104-1677
US

V. Phone/Fax

Practice location:
  • Phone: 717-231-8360
  • Fax: 717-231-8358
Mailing address:
  • Phone: 717-231-8539
  • Fax: 717-231-8588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC003950
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: