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General NPI Number Information
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NPI Number | 1598340531
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Entity Type | Individual
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Provider Name | LAUREN MCCLINTOCK LESLIE LISW-CP
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Gender | Female
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Dates
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Enumeration Date | 03/11/2021
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Last Update Date | 03/11/2021
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Provider Practice Location Address
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Address Line | 1180 COLUMBIA AVE STE 203
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City | IRMO
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State | SC
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Zip | 29063-2890
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Country | US
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Telephone | 407-803-0088
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Fax |
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Provider Business Mailing Address
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Address Line | 582 VILLAGE CHURCH DR
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City | CHAPIN
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State | SC
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Zip | 29036-7538
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Country | US
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Telephone | 803-298-4376
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 14105
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License Number State | SC
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