Healthcare Provider Details

I. General information

NPI: 1578780748
Provider Name (Legal Business Name): SALLEY M LESLEY MSW LISW CP ACSW LMF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 RICHLAND ST
COLUMBIA SC
29201
US

IV. Provider business mailing address

1703 RICHLAND ST
COLUMBIA SC
29201
US

V. Phone/Fax

Practice location:
  • Phone: 803-254-5650
  • Fax: 803-254-0012
Mailing address:
  • Phone: 803-254-5650
  • Fax: 803-254-0012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4602
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1707
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: