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General NPI Number Information
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NPI Number | 1710996582
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Entity Type | Individual
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Provider Name | CYNTHIA K. LESLIE LBSW, MA,
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Gender | Female
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Dates
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Enumeration Date | 08/07/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 3847 PINE GROVE AVE STE A
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City | FORT GRATIOT
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State | MI
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Zip | 48059-4265
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Country | US
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Telephone | 810-966-3731
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Fax |
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Provider Business Mailing Address
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Address Line | 3148 WEXFORD CIR
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City | PORT HURON
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State | MI
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Zip | 48060-7792
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Country | US
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Telephone | 810-966-3731
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6401006881
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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 | 6802033987
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License Number State | MI
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