Provider Demographics
NPI:1154375434
Name:ADKISON, LESLIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:
Last Name:ADKISON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12642 PIERCY RD FL 32404
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-2764
Mailing Address - Country:US
Mailing Address - Phone:850-763-0017
Mailing Address - Fax:
Practice Address - Street 1:1137 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2498
Practice Address - Country:US
Practice Address - Phone:850-628-0910
Practice Address - Fax:850-769-2366
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW72801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical