Provider Demographics
NPI:1063188597
Name:PREVEAUX, LESLIE C
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:C
Last Name:PREVEAUX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5607 BLANCHARD PL
Mailing Address - Street 2:
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-7930
Mailing Address - Country:US
Mailing Address - Phone:404-207-5253
Mailing Address - Fax:
Practice Address - Street 1:5607 BLANCHARD PL
Practice Address - Street 2:
Practice Address - City:SUGAR HILL
Practice Address - State:GA
Practice Address - Zip Code:30518-7930
Practice Address - Country:US
Practice Address - Phone:404-207-5253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor