Provider Demographics
NPI:1518332089
Name:WILLIAMS, LESLIE CHURN (LPC, LMHP, CHT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:CHURN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPC, LMHP, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 SHOREWOOD PL
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4973
Mailing Address - Country:US
Mailing Address - Phone:571-278-4178
Mailing Address - Fax:
Practice Address - Street 1:36086 LANKFORD HIGHWAY
Practice Address - Street 2:308
Practice Address - City:BELLE HAVEN
Practice Address - State:VA
Practice Address - Zip Code:23306
Practice Address - Country:US
Practice Address - Phone:571-278-4178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005451101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA100Medicaid