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General NPI Number Information
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NPI Number | 1245507060
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Entity Type | Individual
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Provider Name | MRS. LESLIE LYNN
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Gender | Female
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Dates
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Enumeration Date | 11/22/2011
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Last Update Date | 06/30/2022
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Provider Practice Location Address
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Address Line | 2700 ROBERT T LONGWAY BLVD STE C
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City | FLINT
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State | MI
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Zip | 48503-2190
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Country | US
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Telephone | 810-553-9417
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Fax |
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Provider Business Mailing Address
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Address Line | 2432 W FARRAND RD
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City | CLIO
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State | MI
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Zip | 48420-1015
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Country | US
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Telephone | 810-516-0542
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 6802087097
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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