Provider Demographics
NPI:1114278546
Name:MANN, LESLIE (LMFTA)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:MANN
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4035 UNIVERSITY PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3276
Mailing Address - Country:US
Mailing Address - Phone:336-397-1560
Mailing Address - Fax:336-397-1566
Practice Address - Street 1:4035 UNIVERSITY PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3276
Practice Address - Country:US
Practice Address - Phone:336-397-1560
Practice Address - Fax:336-397-1566
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8050A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist