Provider Demographics
NPI:1366525958
Name:PHILLIPS, LESLIE LALANE (MS, LPC, NCC)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:LALANE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 LOWER DRY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LACEYS SPRING
Mailing Address - State:AL
Mailing Address - Zip Code:35754-3720
Mailing Address - Country:US
Mailing Address - Phone:256-690-4982
Mailing Address - Fax:
Practice Address - Street 1:1132 LOWER DRY CREEK RD
Practice Address - Street 2:
Practice Address - City:LACEYS SPRING
Practice Address - State:AL
Practice Address - Zip Code:35754-3720
Practice Address - Country:US
Practice Address - Phone:256-690-4982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2610 - LPC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51537652OtherBCBS