Provider Demographics
NPI:1578215406
Name:SCOTT, LESLIE HARRIS (MED, LPC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:HARRIS
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 CHARLTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-5206
Mailing Address - Country:US
Mailing Address - Phone:434-409-8182
Mailing Address - Fax:
Practice Address - Street 1:943 CHARLTON AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-5206
Practice Address - Country:US
Practice Address - Phone:434-409-8182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010821101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional