Provider Demographics
NPI:1316346711
Name:DR. LESLIE DONNELLY AND ASSOCIATES, LLC
Entity type:Organization
Organization Name:DR. LESLIE DONNELLY AND ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DONNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-742-7160
Mailing Address - Street 1:PO BOX 1627
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21802-1627
Mailing Address - Country:US
Mailing Address - Phone:410-742-7160
Mailing Address - Fax:410-546-1048
Practice Address - Street 1:116-118 WEST MAIN STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-4905
Practice Address - Country:US
Practice Address - Phone:410-742-7160
Practice Address - Fax:410-546-1048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 1041C0700X, 106H00000X
MD03248103TC1900X
MD1111751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty