Healthcare Provider Details

I. General information

NPI: 1992855860
Provider Name (Legal Business Name): BARBARA ANN LESESNE CPSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BOBBIE ANN LESESNE CPSS

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 COLONIAL DR COTTAGE A
COLUMBIA SC
29203-6827
US

IV. Provider business mailing address

3906 THORNWELL CT APT A
COLUMBIA SC
29205-4119
US

V. Phone/Fax

Practice location:
  • Phone: 803-898-8133
  • Fax: 803-898-2194
Mailing address:
  • Phone: 803-738-8234
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: