Provider Demographics
NPI:1285020859
Name:KRAUSE, LESLIE LYNN (MA)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:LYNN
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:LYNN
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 NATIONAL GUARD RD
Mailing Address - Street 2:J1.1 STOP BOX 46
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-4752
Mailing Address - Country:US
Mailing Address - Phone:803-727-2092
Mailing Address - Fax:
Practice Address - Street 1:1225 BLUFF RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-4714
Practice Address - Country:US
Practice Address - Phone:803-727-2092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional