MEDICARE: LESLE BETH WICKLINE M.ED

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	101Y00000X	Counselor	954	WV

General Provider Information

NPI Number	:	1598612855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLE BETH WICKLINE M.ED

Provider Business Mailing Address
First Line	:	1 KENTON DR STE 200
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25311-1256
Country	:	US
Telephone Number	:	304-408-3292
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 KENTON DR STE 200
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25311-1256
Country	:	US
Telephone Number	:	304-408-3292
Fax Number	:

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

Provider Enumeration Date	:	03/14/2026
Last Update Date	:	03/14/2026

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