Provider Demographics
NPI:1215576665
Name:ADDISON, LESLIE BRETT (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:BRETT
Last Name:ADDISON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 GIPPY CT
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-8572
Mailing Address - Country:US
Mailing Address - Phone:803-645-9238
Mailing Address - Fax:
Practice Address - Street 1:5210 WOODSIDE EXECUTIVE CT
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-3816
Practice Address - Country:US
Practice Address - Phone:803-226-0275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7305101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health