Provider Demographics
NPI:1033498647
Name:PERSILY, LESLEY ANNE (LPC)
Entity Type:Individual
Prefix:MS
First Name:LESLEY
Middle Name:ANNE
Last Name:PERSILY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3616 DORADO CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-3836
Mailing Address - Country:US
Mailing Address - Phone:703-383-9897
Mailing Address - Fax:
Practice Address - Street 1:9675 MAIN STREET
Practice Address - Street 2:SUITE A
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031
Practice Address - Country:US
Practice Address - Phone:703-349-5459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005084101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health