Healthcare Provider Details

I. General information

NPI: 1891853784
Provider Name (Legal Business Name): LESLIE M. DURR PHD, PMHCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 05/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1149 ROSE HILL DR
CHARLOTTESVILLE VA
22903-5161
US

IV. Provider business mailing address

3074 DOCTORS XING
CHARLOTTESVILLE VA
22911-5733
US

V. Phone/Fax

Practice location:
  • Phone: 434-293-2611
  • Fax: 434-296-2928
Mailing address:
  • Phone: 434-973-2062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number0015000153
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License Number0015000153
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: