Provider Demographics
NPI:1558304683
Name:SELTZER, LEILANI (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LEILANI
Middle Name:
Last Name:SELTZER
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 1:2025 HADLEY CT
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103
Mailing Address - Country:US
Mailing Address - Phone:336-765-3032
Mailing Address - Fax:336-760-6977
Practice Address - Street 1:1396 OLD MILL CIRCLE
Practice Address - Street 2:SOTILE PSYCHOLOGICAL ASSOCIATES, PLLC
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103
Practice Address - Country:US
Practice Address - Phone:336-765-3032
Practice Address - Fax:336-760-6977
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCOO23631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical