Provider Demographics
NPI:1699027607
Name:HOLLEY, LESLIE (LCPC, LPC)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:
Last Name:HOLLEY
Suffix:
Gender:F
Credentials:LCPC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8730 GEORGIA AVE STE 200D
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3604
Mailing Address - Country:US
Mailing Address - Phone:312-624-8610
Mailing Address - Fax:
Practice Address - Street 1:8730 GEORGIA AVE STE 200D
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3604
Practice Address - Country:US
Practice Address - Phone:312-775-2316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2019-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC14906101YP2500X
IL178.008404101YP2500X
VA0701007056101YP2500X
MO2016034637101YP2500X
MDLC8173101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional