Healthcare Provider Details

I. General information

NPI: 1992588214
Provider Name (Legal Business Name): LESLIE DANA BOTTOMS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2023
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10806 FARMSTEAD MILL LN
GLEN ALLEN VA
23059-8098
US

IV. Provider business mailing address

10806 FARMSTEAD MILL LN
GLEN ALLEN VA
23059-8098
US

V. Phone/Fax

Practice location:
  • Phone: 540-287-4023
  • Fax:
Mailing address:
  • Phone: 571-412-1912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: