Provider Demographics
NPI:1699299784
Name:SIMMONS, LESLIE RENEE (MSW, LCSWA)
Entity type:Individual
Prefix:MISS
First Name:LESLIE
Middle Name:RENEE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E STONEWALL ST STE 601
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-2781
Mailing Address - Country:US
Mailing Address - Phone:980-355-1428
Mailing Address - Fax:
Practice Address - Street 1:5501 EXECUTIVE CENTER DR STE 238
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-8867
Practice Address - Country:US
Practice Address - Phone:704-281-0514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0118441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical