Provider Demographics
NPI:1003976580
Name:LESLIE, LYNDA HALE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LYNDA
Middle Name:HALE
Last Name:LESLIE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 HUGUENOT RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-2397
Mailing Address - Country:US
Mailing Address - Phone:804-263-3775
Mailing Address - Fax:804-325-1670
Practice Address - Street 1:1700 HUGUENOT RD
Practice Address - Street 2:SUITE D
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2397
Practice Address - Country:US
Practice Address - Phone:804-263-3775
Practice Address - Fax:804-325-1670
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09044005775101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA146391OtherANTHEM
VA540505877OtherTRICARE
VA010052114Medicaid
VA086279MOtherSENTARA