Provider Demographics
NPI:1083074918
Name:MCDONALD, LESLIE RYAN (MA)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:RYAN
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 RIVERS ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649-8513
Mailing Address - Country:US
Mailing Address - Phone:864-227-1001
Mailing Address - Fax:864-227-3619
Practice Address - Street 1:1612 RIVERS ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649-8513
Practice Address - Country:US
Practice Address - Phone:864-227-1001
Practice Address - Fax:864-227-3619
Is Sole Proprietor?:No
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)