MEDICARE: LESLIE CHRISTIAN MA LPC NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	2738	NC

General Provider Information

NPI Number	:	1093975849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE CHRISTIAN MA LPC NCC

Provider Business Mailing Address
First Line	:	41068 CALLA LILY
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29707-5815
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	41068 CALLA LILY ST
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29707-5815
Country	:	US
Telephone Number	:	803-396-1449
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2008
Last Update Date	:	06/16/2008

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