Provider Demographics
NPI:1205019262
Name:THEARD, LESLIE A (LCSW)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:A
Last Name:THEARD
Suffix:
Gender:F
Credentials: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 865
Mailing Address - Street 2:
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94585-0865
Mailing Address - Country:US
Mailing Address - Phone:707-366-4277
Mailing Address - Fax:707-673-2232
Practice Address - Street 1:1545 WEBSTER ST STE A
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-4917
Practice Address - Country:US
Practice Address - Phone:707-366-4277
Practice Address - Fax:707-673-2232
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-13
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS241081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty