Provider Demographics
NPI:1295865459
Name:HARDY, LESLIE M (MSW, LCSW, LCAS)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:M
Last Name:HARDY
Suffix:
Gender:F
Credentials:MSW, LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 58098
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27658-8098
Mailing Address - Country:US
Mailing Address - Phone:919-434-3555
Mailing Address - Fax:919-981-7373
Practice Address - Street 1:809 SPRING FOREST RD STE 1000
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-9147
Practice Address - Country:US
Practice Address - Phone:919-434-3555
Practice Address - Fax:919-665-5095
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0047301041C0700X
NCC0036631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106329Medicaid