Provider Demographics
NPI:1083946800
Name:LESNIEWICZ, ANDREW J (PCC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:J
Last Name:LESNIEWICZ
Suffix:
Gender:M
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 S MCCORD RD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-9656
Mailing Address - Country:US
Mailing Address - Phone:419-467-9406
Mailing Address - Fax:
Practice Address - Street 1:1514 REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1692
Practice Address - Country:US
Practice Address - Phone:419-467-9406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0501335101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional