Provider Demographics
NPI:1083600043
Name:WARREN, LESA DONISE (LMSW-ACP, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LESA
Middle Name:DONISE
Last Name:WARREN
Suffix:
Gender:F
Credentials:LMSW-ACP, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5725
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75505-5725
Mailing Address - Country:US
Mailing Address - Phone:903-334-8022
Mailing Address - Fax:
Practice Address - Street 1:5321 SUMMERHILL RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-1827
Practice Address - Country:US
Practice Address - Phone:903-334-8022
Practice Address - Fax:903-334-7019
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX327261041C0700X
AR1716-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B3219Medicare ID - Type Unspecified
TXP67585Medicare UPIN