Provider Demographics
NPI:1518548890
Name:BUNTING, LESLIE BLUE (LCSW)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:BLUE
Last Name:BUNTING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 KREADY AVE
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17551-2005
Mailing Address - Country:US
Mailing Address - Phone:717-201-5656
Mailing Address - Fax:
Practice Address - Street 1:79 E MAIN ST STE 302
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-1941
Practice Address - Country:US
Practice Address - Phone:717-455-0797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-18
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor