Provider Demographics
NPI:1275098162
Name:STOVER, LESLIE DIANE
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:DIANE
Last Name:STOVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 GATEWAY BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-5544
Mailing Address - Country:US
Mailing Address - Phone:253-346-1377
Mailing Address - Fax:
Practice Address - Street 1:10430 HARRIS OAK BLVD STE L
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-7513
Practice Address - Country:US
Practice Address - Phone:704-317-2930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool