Provider Demographics
NPI:1407525454
Name:WARREN, LESLIE L (LICSW PIP)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:L
Last Name:WARREN
Suffix:
Gender:F
Credentials:LICSW PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 COUNTY ROAD 1419
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058-0531
Mailing Address - Country:US
Mailing Address - Phone:256-347-7712
Mailing Address - Fax:
Practice Address - Street 1:269 COUNTY ROAD 1419
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-0531
Practice Address - Country:US
Practice Address - Phone:256-347-7712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-12
Last Update Date:2021-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1484-4130C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty