Provider Demographics
NPI:1114784063
Name:GREENE, LESLIE MARIE (BA, COMMUNITY DOULA)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:MARIE
Last Name:GREENE
Suffix:
Gender:F
Credentials:BA, COMMUNITY DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 HOLLOW OAK LN APT 101
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-4579
Mailing Address - Country:US
Mailing Address - Phone:512-351-0730
Mailing Address - Fax:
Practice Address - Street 1:5700 HOLLOW OAK LN APT 101
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-4579
Practice Address - Country:US
Practice Address - Phone:512-351-0730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA4318374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula