Provider Demographics
NPI:1508635582
Name:OWENS, LESLIE (FDN-P, BCHHP)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:OWENS
Suffix:
Gender:F
Credentials:FDN-P, BCHHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12042 CHEVIOTT HILL LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-3896
Mailing Address - Country:US
Mailing Address - Phone:704-293-9770
Mailing Address - Fax:
Practice Address - Street 1:12042 CHEVIOTT HILL LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-3896
Practice Address - Country:US
Practice Address - Phone:704-293-9770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-01
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach