Provider Demographics
NPI:1124768403
Name:LESKAUSKAS, MARIE (LCMHCA, LAC, MA)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:LESKAUSKAS
Suffix:
Gender:F
Credentials:LCMHCA, LAC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 PENINSULA DR
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-7200
Mailing Address - Country:US
Mailing Address - Phone:704-918-3380
Mailing Address - Fax:980-689-2738
Practice Address - Street 1:709 PENINSULA DR
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-7200
Practice Address - Country:US
Practice Address - Phone:704-918-3380
Practice Address - Fax:980-689-2738
Is Sole Proprietor?:No
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00485800101YM0800X
NCA16779101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health