Provider Demographics
NPI:1235202276
Name:DOEHRING, LESLIE KIM (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:KIM
Last Name:DOEHRING
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 WEST CROSSVILLE ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2506
Mailing Address - Country:US
Mailing Address - Phone:678-494-0089
Mailing Address - Fax:770-643-4854
Practice Address - Street 1:580 WEST CROSSVILLE ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2506
Practice Address - Country:US
Practice Address - Phone:678-494-0089
Practice Address - Fax:770-643-4854
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2553103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical