Provider Demographics
NPI:1598340531
Name:LESLIE, LAUREN MCCLINTOCK (LISW-CP)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:MCCLINTOCK
Last Name:LESLIE
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:MCCLINTOCK-LESLIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LISW-CP
Mailing Address - Street 1:582 VILLAGE CHURCH DR
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-7538
Mailing Address - Country:US
Mailing Address - Phone:803-298-4376
Mailing Address - Fax:
Practice Address - Street 1:1180 COLUMBIA AVE STE 203
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2890
Practice Address - Country:US
Practice Address - Phone:407-803-0088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC141051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical