Provider Demographics
NPI:1992440937
Name:LILES, LESLIE A (MCAP)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:A
Last Name:LILES
Suffix:
Gender:F
Credentials:MCAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39352 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-6844
Mailing Address - Country:US
Mailing Address - Phone:181-369-6570
Mailing Address - Fax:
Practice Address - Street 1:39352 6TH AVE
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-6844
Practice Address - Country:US
Practice Address - Phone:813-696-5706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMCAP100501101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3527734Medicaid