Provider Demographics
NPI:1154143915
Name:CROUCH, LESLEY SMITH (M ED, BCBA, LBA)
Entity type:Individual
Prefix:MRS
First Name:LESLEY
Middle Name:SMITH
Last Name:CROUCH
Suffix:
Gender:F
Credentials:M ED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 TARLETON DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-2957
Mailing Address - Country:US
Mailing Address - Phone:804-691-0233
Mailing Address - Fax:
Practice Address - Street 1:301 PINE AVE
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-4761
Practice Address - Country:US
Practice Address - Phone:540-946-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01-20-46164103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst