Provider Demographics
NPI:1588231112
Name:SHERIDAN, LESLIE SITKOFF (LPC, CAADC, NCC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:SITKOFF
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:LPC, CAADC, NCC
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:MARGOT
Other - Last Name:SITKOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:852 CHANDLEE DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-1976
Mailing Address - Country:US
Mailing Address - Phone:610-506-5448
Mailing Address - Fax:
Practice Address - Street 1:1640 POWERS FERRY RD SE STE 200
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-5491
Practice Address - Country:US
Practice Address - Phone:770-575-1696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010587101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional