Provider Demographics
NPI:1417289497
Name:MUSSINGTON, LESLIE A
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:A
Last Name:MUSSINGTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 RINGTAIL CT
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-6239
Mailing Address - Country:US
Mailing Address - Phone:704-699-5899
Mailing Address - Fax:
Practice Address - Street 1:4140 RINGTAIL CT
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-6239
Practice Address - Country:US
Practice Address - Phone:704-699-5899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0051701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical