Provider Demographics
NPI:1255856282
Name:DAVIS, LESLIE (MA,LCPC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA,LCPC
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LCPC
Mailing Address - Street 1:7 EAGLE CTR STE B1
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1946
Mailing Address - Country:US
Mailing Address - Phone:314-529-0214
Mailing Address - Fax:618-726-2043
Practice Address - Street 1:7 EAGLE CTR STE B1
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1946
Practice Address - Country:US
Practice Address - Phone:618-726-2041
Practice Address - Fax:618-726-2043
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor