Provider Demographics
NPI:1386970358
Name:MCQUARY, LESLIE LEWALLEN
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:LEWALLEN
Last Name:MCQUARY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 PROVIDENCE MINE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-2945
Mailing Address - Country:US
Mailing Address - Phone:530-575-8179
Mailing Address - Fax:530-265-7849
Practice Address - Street 1:202 PROVIDENCE MINE RD STE 105
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-2945
Practice Address - Country:US
Practice Address - Phone:530-575-8179
Practice Address - Fax:530-265-7849
Is Sole Proprietor?:No
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor