Provider Demographics
NPI:1427829977
Name:SMITH, LESLIE RENO (LCMHCA)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:RENO
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 GWYN AVE
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-3422
Mailing Address - Country:US
Mailing Address - Phone:510-619-6810
Mailing Address - Fax:
Practice Address - Street 1:714 CAROLINA AVE STE A
Practice Address - Street 2:
Practice Address - City:YADKINVILLE
Practice Address - State:NC
Practice Address - Zip Code:27055-7793
Practice Address - Country:US
Practice Address - Phone:336-818-0733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19564101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional