Provider Demographics
NPI:1578733507
Name:OWENS, M. LESLIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:M. LESLIE
Middle Name:
Last Name:OWENS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:LESLIE
Other - Last Name:OWENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:7318 RIDGEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-9155
Mailing Address - Country:US
Mailing Address - Phone:704-770-7743
Mailing Address - Fax:704-912-2934
Practice Address - Street 1:7318 RIDGEFIELD DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-9155
Practice Address - Country:US
Practice Address - Phone:704-770-7743
Practice Address - Fax:704-912-2934
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0055951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical