Provider Demographics
NPI:1417666181
Name:ROGERS, LESLIE S (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:S
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:S
Other - Last Name:LESANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2501 BRAGG BLVD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-4141
Mailing Address - Country:US
Mailing Address - Phone:301-636-0419
Mailing Address - Fax:910-338-4713
Practice Address - Street 1:2501 BRAGG BLVD BLDG A
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4141
Practice Address - Country:US
Practice Address - Phone:301-636-0419
Practice Address - Fax:910-338-4713
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPA6178103T00000X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist