Provider Demographics
NPI:1467783811
Name:OGUNGBEMI, LESLY THREADGILL (MSW - LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:LESLY
Middle Name:THREADGILL
Last Name:OGUNGBEMI
Suffix:
Gender:F
Credentials:MSW - LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525H ELLICOTT MILLS DR STE 108
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-4544
Mailing Address - Country:US
Mailing Address - Phone:410-212-0111
Mailing Address - Fax:
Practice Address - Street 1:3525H ELLICOTT MILLS DR STE 108
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4544
Practice Address - Country:US
Practice Address - Phone:410-212-0111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-25
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD038681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical