Provider Demographics
NPI:1336677970
Name:POOLE, LEZLIE NICOLE (BA,CPS, CPS-WH)
Entity Type:Individual
Prefix:
First Name:LEZLIE
Middle Name:NICOLE
Last Name:POOLE
Suffix:
Gender:F
Credentials:BA,CPS, CPS-WH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 WILLET WAY
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-4630
Mailing Address - Country:US
Mailing Address - Phone:1229-938-5376
Mailing Address - Fax:
Practice Address - Street 1:302 E FURLOW ST
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-4031
Practice Address - Country:US
Practice Address - Phone:229-924-2430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst