Provider Demographics
NPI:1528792009
Name:DUCILLE, LESLEY (RBT)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:
Last Name:DUCILLE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7620 CANNONBALL GATE RD
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-7304
Mailing Address - Country:US
Mailing Address - Phone:540-680-8275
Mailing Address - Fax:
Practice Address - Street 1:7620 CANNONBALL GATE RD
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-7304
Practice Address - Country:US
Practice Address - Phone:540-680-8275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2025-03-05
Deactivation Date:2025-02-06
Deactivation Code:
Reactivation Date:2025-03-05
Provider Licenses
StateLicense IDTaxonomies
VARBT-20-131416106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician