Provider Demographics
NPI:1346788700
Name:MOORE, LESLIE CORINNE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:CORINNE
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:LESLIE
Other - Middle Name:CORINNE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, MSED
Mailing Address - Street 1:2380 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-1847
Mailing Address - Country:US
Mailing Address - Phone:731-882-4730
Mailing Address - Fax:731-287-1795
Practice Address - Street 1:2380 HENRY ST
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-1847
Practice Address - Country:US
Practice Address - Phone:731-287-1794
Practice Address - Fax:731-287-1795
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
TN7083101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator